Deck 15: Assessment of Cardiac Output

Question 1

What change is seen on the CVP waveform when the patient takes a spontaneous deep breath?

A) The waveform falls to baseline.
B) The waveform falls to below baseline.
C) The waveform increases to above baseline.
D) There is no change in the waveform.

Answer 1

The waveform falls to below baseline.

Question 2

Complications of direct arterial monitoring include which the following?
1) Infection
2) Ischemia
3) Hemorrhage
4) Hypotension

A)1 and 4
B)2 and 3
C)1, 2, and 3
D)2, 3, and 4

Answer 2

1, 2, and 3

Question 3

What will the MAP be if the systolic blood pressure is 140 mm Hg and the diastolic blood pressure is 80 mm Hg?

A) 60 mm Hg
B) 100 mm Hg
C) 110 mm Hg
D) 120 mm Hg

Answer 3

100 mm Hg

Question 4

What does the dicrotic notch represent on an arterial pressure waveform?

A) Aortic valve closure
B) Mean arterial pressure
C) A blood pressure increase of 50 to 60 mm Hg
D) An inaccurate pressure reading lower than the actual pressure

Question 5

Which of the following is an advantage of using the internal jugular vein as the insertion site for the central venous catheter?
1) The risk of pneumothorax from pleural puncture is low.
2) Visibility is good if hematomas form around the neck.
3) Tubing is more stable and is less likely to kink in a patient who is awake.
4) It is nearly a straight line from the right internal jugular vein to the right atrium.

A)1 and 3
B)2 and 3
C)1, 2, and 4
D)2, 3, and 4

Question 6

When the water manometer is used to measure the CVP, the reading usually is taken at:

A) peak inspiration with the patient in the semi-Fowler position.
B) the end of expiration with the patient in the supine position.
C) the end of inspiration with the head of the bed elevated 45 degrees.
D) any time during inspiration or expiration with the head of the bed elevated 45 degrees.

Question 7

The CVP catheter insertion site that provides both stability after placement and accurate hemodynamic information is the _____ vein.

A) external jugular
B) internal jugular
C) subclavian
D) femoral

Question 8

Both the CVP and the pulmonary artery wedge pressure waveforms have three waves for each cycle, namely:

A) waves a, c, and v.
B) waves q, r, and s.
C) waves p, t, and u.
D) waves p, r, and v.

Question 9

During systole, the CVP "v" waveform is exaggerated and the CVP increases. This most likely is due to:

A) a kink in the tubing.
B) air bubbles in the catheter.
C) an incompetent tricuspid valve.
D) incorrect positioning of the measuring instrument with respect to the right atrium.

Question 10

Monitoring of the CVP is indicated when there is a need to assess which of the following?
1) The circulating blood volume
2) The degree of venous return
3) The left ventricular function
4) Medication efficacy

A)1 and 2
B)3 and 4
C)1, 3, and 4
D)2, 3, and 4

Question 11

The most common site for arterial catheterization is the _____ artery.

A) radial
B) axillary
C) femoral
D) brachial

Question 12

Which of the following techniques is used most commonly to insert an arterial pressure monitoring catheter?

A) Needle-through-needle technique
B) Judkins technique
C) Seldinger technique
D) Sones technique

Question 13

The "a" wave would be absent in which of the following dysrhythmias?

A) Sinus bradycardia
B) First-degree heart block
C) Third-degree heart block
D) Atrial fibrillation

Question 14

Arterial cannulation is indicated for which of the following?
1) Determining cardiac output
2) Severe hypotension
3) Unstable respiratory failure
4) Avoiding arterial injury from multiple arterial punctures

A)1 and 2
B)3 and 4
C)1, 3, and 4
D)2, 3, and 4

Question 15

Circulation to the vital organs (kidneys, coronary arteries) may be compromised if the MAP falls to below _____ mm Hg.

A) 60
B) 80
C) 100
D) 120

Question 16

An increase in CVP during inspiration most likely is caused by:

A) a mechanical breath.
B) a spontaneous breath.
C) the instrument not being zero-balanced correctly.
D) the catheter being inserted into the right ventricle.

Question 17

The CVP represents which of the following?
1) The left ventricular preload
2) The pressure of blood in the right atrium
3) The right ventricular end-diastolic pressure
4) The right ventricular preload

A)1 only
B)2 and 3
C)1, 2, and 3
D)2, 3, and 4

Question 18

When vasodilators such as sodium nitroprusside are administered, it is important to monitor the fall in blood pressure because low blood pressure can:

A) cause arterial spasm.
B) cause a stroke in obese adult patients.
C) decrease blood flow to the coronary arteries.
D) increase the likelihood that pulmonary edema may develop.

Question 19

An exaggerated "v" wave would be found in which of the following conditions?

A) Atrial fibrillation
B) Tricuspid regurgitation
C) Ventricular diastole
D) Third-degree heart block

Question 20

The pulse pressure is important hemodynamically because it is an indication of:

A) central venous pressure (CVP).
B) mean arterial pressure (MAP).
C) right ventricular stroke volume.
D) left ventricular stroke volume.

Question 21

Which of the following cause an increase in the CVP?
1) Volume overload
2) Tension pneumothorax
3) Spontaneous inspiration
4) Increased intrathoracic pressure

A)1 and 3
B)2 and 3
C)1, 2, and 4
D)2, 3, and 4

Question 22

According to West, which zone is dominant in the supine position?

A) I
B) II
C) III
D) IV

Question 23

If, when the pulmonary artery catheter is inserted, there is a rapid increase in the height of the pressure waveforms with the downstroke dropping near zero, the respiratory therapist should:

A) continue the insertion because the catheter now has entered the right ventricle.
B) deflate the balloon and withdraw the catheter because it is curling within the atrium.
C) withdraw the catheter because it has been jammed into the heart wall.
D) inflate the balloon to prevent further damage because the ventricular septum has ruptured.

Question 24

When the pulmonary artery catheter is inserted, the balloon is inflated in the right atrium before it is inserted further. This is done to:

A) allow the catheter to float.
B) decrease the risk of premature ventricular contractions.
C) allow the catheter to enter the right ventricle more easily.
D) make the catheter more visible on a chest x-ray.

Question 25

The CVP can be used to estimate left ventricular filling pressures if there is no left ventricular dysrhythmia and the ejection fraction is greater than:

A) 0.20.
B) 0.30.
C) 0.40.
D) 0.50.

Question 26

For the pulmonary capillary wedge pressure to reflect pulmonary venous and left atrial pressures, blood flow must be uninterrupted between the catheter tip and the left heart. This condition exists only in West zone:

A) I.
B) II.
C) III.
D) IV.

Question 27

In left ventricular failure, the pulmonary capillary wedge pressure is expected to:

A) fall to zero.
B) remain in the normal range.
C) increase to above the normal range.
D) decrease to below the normal range.

Question 28

Large fluctuations in the net distending pressure within the left ventricle, also known as the transmural pressure, are seen in which of the following situations?
1) Coughing
2) Valsalva maneuver
3) Positive-pressure ventilation
4) Hemorrhage

A)1 and 3
B)2 and 3
C)1, 2, and 3
D)2, 3, and 4

Question 29

With a properly inserted and positioned pulmonary artery catheter, a systolic pressure reading in the pulmonary artery of 50 mm Hg could be due to:

A) pulmonary vasodilation.
B) tricuspid valve stenosis.
C) pulmonic valve stenosis.
D) chronic obstructive pulmonary disease (COPD).

Question 30

A shift to zone I or II may occur if which of the following conditions is present?
1) Hypovolemia
2) Increased PEEP
3) Hemorrhage
4) Decrease in PEEP

A)1 and 3
B)2 and 3
C)1, 2, and 3
D)2, 3, and 4

Question 31

Pulmonary artery catheter monitoring is likely to be considered for patients with which of the following conditions?
1) ARDS
2) Pulmonary embolus
3) Cardiogenic pulmonary edema
4) Septic shock

A)1 and 2
B)3 and 4
C)1, 3, and 4
D)2, 3, and 4

Question 32

A difference between the pulmonary artery diastolic pressure and the pulmonary capillary wedge pressure greater than 5 mm Hg is seen in which of the following conditions?

A) ARDS
B) Sepsis
C) Excessive positive end-expiratory pressure (PEEP)
D) All of the above

Question 33

Complications involving the use of CVP catheters include which of the following?
1) Bleeding
2) Pneumothorax
3) Infection
4) Atrial septal puncture

A)1 and 3
B)2 and 3
C)1, 2, and 3
D)2, 3, and 4

Question 34

The normal range for pulmonary artery systolic pressure is _____ mm Hg.

A) 0 to 10
B) 10 to 20
C) 20 to 30
D) 30 to 40

Question 35

The normal range for pulmonary artery diastolic pressure is _____ mm Hg.

A) 0 to 8
B) 8 to 15
C) 15 to 28
D) 28 to 35

Question 36

The CVP is most likely to correlate well with left ventricular filling pressure in which of the following patients?

A) Male, age 20 years, scheduled for surgery for mitral valve stenosis repair
B) Female, age 52 years, scheduled for coronary artery bypass grafting in four arteries
C) Male, age 37 years, receiving care in the intensive care unit (ICU) for acute respiratory distress syndrome (ARDS)
D) Female, age 25 years, recovering well after abdominal surgery

Question 37

The normal pulmonary capillary wedge pressure is _____ mm Hg.

A) 0 to 6
B) 4 to 12
C) 10 to 15
D) 12 to 18

Question 38

Which of the following cause a decrease in the CVP?

A) Peripheral vasodilation
B) Right ventricular failure
C) Pulmonary hypertension
D) Positive-pressure mechanical ventilation

Question 39

An increase in pulmonary artery systolic pressure is seen in patients with which of the following conditions?
1) Pulmonary embolus
2) Mitral valve stenosis
3) Right ventricular failure
4) Hypoxia and hypoxemia

A)1 and 3
B)2 and 3
C)1, 2, and 4
D)2, 3, and 4

Question 40

The purpose of the balloon at the tip of the pulmonary artery catheter is to:

A) obtain wedge pressure measurements.
B) sense temperature changes in the blood.
C) make the catheter more visible on a chest x-ray.
D) provide a place for slow-release medication to be stored before it is released.

Question 41

PEEP levels lower than what value will have a limited effect on intrapleural pressure?

A) 5 cm H₂O
B) 10 cm H₂O
C) 15 cm H₂O
D) 20 cm H₂O

Question 42

Which of the following are potential hazards of pulmonary artery catheter migration?
1) Air embolus
2) Dysrhythmias
3) Pulmonary artery rupture
4) Pulmonary infarction

A)1 and 2
B)3 and 4
C)1, 3, and 4
D)2, 3, and 4

Question 43

A patient with a newly inserted pulmonary catheter begins to cough up blood-tinged sputum. The most likely cause for this is:

A) pneumothorax.
B) pulmonary embolus.
C) pulmonary infarction.
D) perforation of the heart muscle.

Question 44

Which of the following interventions is intended to minimize central line-associated bloodstream infections?

A) Opting to not place a central line
B) Replacing gauze dressing every 12 h
C) Central line bundles
D) Physician only central line placement