Question 1

The nurse is caring for a patient who has invasive hemodynamic monitoring. What is the nurse's highest priority of care for this patient?

Accepted Answer

Ensuring that alarm limits are set and monitor alarms are on is the highest priority to promptly detect and respond to any critical changes in the patient's hemodynamic status.

Question 2

The nurse is caring for a patient in the critical care area whose fluid volume status needs to be assessed closely. The nurse would expect which type of monitoring to be used?

Accepted Answer

Central venous pressure (CVP) monitoring is commonly used to assess fluid volume status in critically ill patients. It provides information about the pressure and volume of blood returning to the heart, which reflects the preload of the heart and can guide fluid management. Arterial pressure monitoring and pulmonary artery pressure monitoring are more invasive and used for different purposes, such as hemodynamic monitoring, blood pressure management, and cardiac output monitoring. Intra-aortic balloon pump monitoring is also an invasive procedure used to assist the heart's function and is not directly related to fluid volume assessment.

Question 3

A critically ill patient is admitted for the treatment of sepsis. The right arterial BP is 90/60, the central venous pressure is 2, and the pulmonary arterial pressure is 20/

Accepted Answer

All of the patient's pressures are low, indicating that the patient may be hypotensive and need additional fluids. The pulmonary arterial pressure is within normal range, so there is no indication of a pulmonary issue at this time. However, the nurse should continue to monitor the patient closely due to the sepsis.

Question 4

A family member of a critically ill patient is verbalizing the purpose of hemodynamic monitoring. Which statement indicates that the family member needs more education?

Accepted Answer

Hemodynamic monitoring primarily measures the blood flow, blood pressure, and oxygen levels in the blood, but it does not directly measure the volume of blood in the arteries and veins. This misunderstanding indicates a need for more education.

Question 5

A patient's central venous pressure reading is 8 mmHg. The nurse understands this reading reflects which physiological parameter?

Accepted Answer

Central venous pressure (CVP) reflects the blood pressure within the right atrium, which is the chamber that receives blood from the body. A CVP reading of 8 mmHg is within the normal range (2-8 mmHg) and indicates adequate filling of the right side of the heart. CVP is an important parameter to monitor in critically ill patients, as changes in CVP can indicate changes in fluid status, cardiac function, and/or intravascular volume.

Question 6

The patient in the critical care area has an invasive hemodynamic pressure monitoring line. Where would the nurse mark the patient's phlebostatic axis?

Accepted Answer

The phlebostatic axis is located at the fourth intercostal space, halfway between the anterior and posterior chest walls. This is the reference point for leveling transducers to ensure accurate hemodynamic pressure readings.

Question 7

A patient is concerned about the arterial line waveform pattern because there is a break in the downward slope of the pattern and "something must be wrong" because it is not a smooth line. What is the nurse's best response?

Accepted Answer

The break in the downward slope of the arterial line waveform pattern is called a dicrotic notch, and it occurs when the aortic valve closes and marks the beginning of the resting phase of the heart. It is a normal finding and not a cause for concern. Providing the patient with an explanation can help alleviate their concerns.

Question 8

When comparing arterial, central venous, and pulmonary arterial pressures, the nurse keeps which factor in mind?

Accepted Answer

The normal pressure in the right atrium of the heart is indeed very low, typically ranging from 4 to 6 mmHg. This reflects the pressure at the end of the venous system, just before blood enters the right ventricle.

Question 9

The intensive care unit nurse would expect pulmonary artery (PA) catheter monitoring to be used with a patient in which situation?

Accepted Answer

Pulmonary artery (PA) catheter monitoring is used to evaluate left ventricular pressures, making option D the correct choice. PA catheter monitoring is not typically used when a patient cannot tolerate hemodynamic monitoring, as it requires an invasive procedure. A central catheter is used for total parenteral nutrition, but PA catheter monitoring is not necessary for this purpose. Similarly, the need for a peripheral intravenous catheter for vasoactive medication administration would not require PA catheter monitoring.

Question 10

The nurse is in orientation for a new job caring for patients in the intensive care area. Which statement indicates to the preceptor that the new nurse needs more information about hemodynamic monitoring?

Accepted Answer

This statement is incorrect as hemodynamic monitoring does not always require catheterization of the pulmonary artery. Some methods, such as noninvasive blood pressure monitoring, do not involve insertion of catheters. Therefore, the nurse needs more information about the different methods of hemodynamic monitoring.

Question 11

Which information is essential for the nurse to keep in mind when monitoring a patient's central venous pressure?

Accepted Answer

An increasing trend in central venous pressure can indicate fluid overload, which may lead to pulmonary congestion or edema, as the heart struggles to manage the increased volume.

Question 12

The nurse has noted increasing afterload in a patient in the ICU. How would the nurse expect this increase to affect the patient's cardiac output?

Accepted Answer

Afterload refers to the resistance the left ventricle must overcome to circulate blood. High afterload, often due to high systemic vascular resistance, can decrease cardiac output because the heart must work harder to pump blood against this resistance.

Question 13

The nurse is preparing to inflate a pulmonary artery catheter (PAC) balloon while it is located in the pulmonary artery. What assessment is possible from this action?

Accepted Answer

When the balloon of a pulmonary artery catheter (PAC) is inflated while in the pulmonary artery, it allows for the indirect measurement of pressures in the left side of the heart, such as the pulmonary capillary wedge pressure (PCWP), which reflects left atrial pressure.

Question 14

While caring for a patient with a right radial arterial line, the nurse assesses that the fingers of the right hand are cool, pale, and dusky. Which intervention would be important to do first?

Accepted Answer

Cool, pale, and dusky fingers can indicate poor arterial perfusion and could be a sign of arterial insufficiency. This is a medical emergency that requires immediate physician notification to intervene promptly. The nurse should also assess the patient's vital signs and oxygen saturation and compare the right radial arterial line pressure to other sources of blood pressure to detect any discrepancies.

Question 15

A patient with an arterial line has just been turned and repositioned. After leveling the transducer, what should the nurse do next?

Accepted Answer

After turning and repositioning a patient with an arterial line, the transducer must be re-zeroed to ensure accurate blood pressure readings. Therefore, the next step for the nurse is to zero the transducer. A, C, and D are not necessary or appropriate steps in this situation.

Question 16

While caring for a patient with a pulmonary arterial catheter, the nurse notes that the number of centimeters of exposed catheter has decreased. What nursing action is indicated?

Accepted Answer

If the number of centimeters of exposed catheter has decreased, this may indicate that the catheter has migrated or moved from its original placement. This could be a serious complication and requires immediate medical attention. A chest X-ray may be required to check the placement of the catheter. This should be reported to the healthcare provider immediately. Flushing the ports, obtaining a pulmonary artery occlusion pressure, or zero balancing the system would not address the issue of the catheter migration and would not be appropriate actions in this situation.

Question 17

The role of the nurse who is caring for a patient with invasive hemodynamic monitoring includes which important interventions?

Accepted Answer

The role of the nurse caring for a patient with invasive hemodynamic monitoring includes frequent reassessment and evaluation of data in order to tailor therapies to the patient. This involves monitoring the patient's blood pressure, heart rate, and other vital signs, as well as assessing the patient's response to interventions such as fluid and medication administration. Additionally, the nurse must ensure that the hemodynamic line is being used only for monitoring pressures and not for infusing IV fluids, and that the transducer is zero referenced to the level of the phlebostatic axis, not the radial artery. Keeping IV solutions at atmospheric pressure may lead to inaccurate patient pressures.

Question 18

The nurse is attempting to increase contractility to improve cardiac output in a patient with acute exacerbation of heart failure. Which measure would be helpful to improve cardiac contractility?

Accepted Answer

Correcting oxygenation and mild respiratory acidosis can improve contractility by increasing oxygen delivery to the myocardium and decreasing acidosis, which can impair contractility. Administering magnesium sulfate can also improve contractility, but it is not the most helpful measure in this situation. Encouraging the patient to exercise and giving beta-adrenergic blocking medication can have negative effects on contractility in a patient with heart failure.

Question 19

The nurse caring for a patient with hemodynamic monitoring would collaborate with a physician colleague to implement which intervention?

Accepted Answer

The answer of The nurse caring for a patient with...

Question 20

A patient has been diagnosed with an increase in afterload and a CVP reading of 7 mmHg. What should the nurse include in this patient's plan of care?

Accepted Answer

An increase in afterload often indicates decreased cardiac output, which may cause fluid to back up in the body and increase CVP. Diuretic therapy can help to reduce excess fluid and decrease afterload. Providing plasma or intravenous fluids may worsen the fluid overload and exacerbate the afterload, and encouraging an increase in fluids by mouth may further increase the fluid overload.

Quiz 31: Hemodynamic Monitoring