Deck 5: Cardiodynamics and Hemodynamic Regulation

Question 1

A patient is experiencing reduced afterload. What should the nurse identify as causes for this finding? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Sepsis
2) Mitral stenosis
3) Reduced circulating blood volume
4) Vasodilator medications
5) Myocarditis

Answer 1

1, 4
Explanation: 1. Sepsis causes vasodilation due to the release of endotoxins.
2. Mitral stenosis causes increased preload.
3. Reduced circulating blood volume contributes to decreased preload.
4. Vasodilators enlarge the vessels and reduce resistance.
5. Myocarditis contributes to elevated preload.

Question 2

What should the nurse do to correctly calculate cardiac output?
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.

Answer 2

4
Explanation: 1. There could be inconsistency on both temperature and technique.
2. This could cause an inaccurate measurement.
3. There could be inconsistency on both temperature and technique.
4. There could be inconsistency on both temperature and technique. The average of the three closest measurements is standard to reflect accuracy.

Question 3

A patient with an arterial line has an elevated partial thromboplastin time (PTT) and is not on anticoagulation therapy. What should the nurse do?
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.

Answer 3

3
Explanation: 1. This does not need to be done.
2. The elevated partial thromboplastin time would be desired for this situation.
3. Heparinized solutions are contraindicated in patients with coagulation deficiencies or heparin-induced thrombocytopenia.
4. This does not need to be done.

Question 4

Which observation indicates pulsus paradoxus on a patient's arterial pressure waveform?
1) The waveform has tall, tented waves.
2) The pulse pressure is above 20 mm Hg on exhalation.
3) There is a decrease of more than 10 mm Hg in the arterial waveform before inhalation.
4) There is a single, nonperfused beat.

Question 5

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)

Question 6

A patient has a lactate level of 8 mmol/L. What should this finding indicate to the nurse?
1) Carbon dioxide exchange
2) Underuse of oxygen
3) Glucose metabolism
4) Tissue hypoxia

Question 7

Which action 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.

Question 8

A patient asks the nurse, "What is blood pressure?" What should the nurse 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."

Question 9

The nurse is monitoring a patient's pulmonary vascular resistance. Which value is the normal value?
1) 100-250 mm Hg
2) 10-250 dynes/sec/cm²
3) 400-800 mm Hg
4) 900-1,400 dynes/sec/cm²

Question 10

The health care provider is preparing to insert a PA catheter. What action is a priority for the nurse?
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.

Question 11

A patient with a PA catheter has an SVO₂ of 90%. For what should the nurse assess this patient?
1) Fever
2) Pain
3) Hypothermia
4) Anemia

Question 12

A patient has mixed venous oxygen saturation (SVO₂) of 52% with the following hemodynamic findings: CO of 4.8 L/min, SaO₂ of 95%, and an unchanged hemoglobin level. For what should the nurse assess the patient?
1) Excessive sedation
2) Position of the PA catheter
3) Hypothermia
4) Pain

Question 13

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.

Question 14

How should the nurse calculate a patient's mean arterial pressure (MAP)?
1) Divide the systolic pressure by the diastolic pressure.
2) Average three of the patient's blood pressures over a 6-hour period.
3) Divide the diastolic pressure by the pulse pressure.
4) Add the systolic pressure and two diastolic pressures and then divide by 3.

Question 15

What should the nurse use to measure the contractility of the left side of a patient's heart?
1) Left atrial pressure
2) Pulmonary artery wedge pressure
3) Systemic vascular resistance
4) Left ventricular stroke work index

Question 16

A patient has a blood pressure of 134/70 per blood pressure cuff and a blood pressure of 90/50 per arterial line. What action should the nurse take?
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.

Question 17

The nurse is monitoring the PA pressure of a mechanically ventilated patient. When should the nurse obtain the measurement to accurately assess this pressure?
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 of the ventilator

Question 18

What should the nurse monitor in response to a change in SVO₂ readings?
1) Potassium level
2) Glucose level
3) Sodium level
4) Hemoglobin level

Question 19

A patient with a right subclavian triple lumen catheter has a CVP reading of 18 mm Hg. For what symptoms should the nurse assess this patient?
1) Peripheral edema and jugular vein distention
2) Decreased peripheral pulses and cool extremities
3) Hypovolemia and hypotension
4) Orbital edema and disorientation

Question 20

Which value should the nurse recognize is normal for a patient's cardiac output?
1) 6-9 L/min
2) 4-8 L/min
3) 8-10 L/min
4) 2-4 L/min

Question 21

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

Question 22

A patient is admitted with atrial fibrillation. Why should the nurse identify interventions to address low cardiac output for this patient?
1) Loss of atrial kick
2) Pressure in the ventricles
3) Irregular ventricular rhythm
4) Systemic blood from the left ventricle

Question 23

The health care provider is planning to insert a pulmonary artery catheter into a patient. What should the nurse explain to the patient as being the purpose of this device? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
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.

Question 24

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. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
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

Question 25

A patient has a central line for fluid management and antibiotic therapy. What interventions should the nurse use to reduce the risk of infection in the access site? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Practice thorough hand hygiene.
2) Use chlorhexidine skin asepsis.
3) Review the continued need for the line daily.
4) Cover the insertion site with an opaque gauze dressing.
5) Change the dressing over the insertion site using clean technique.

Question 26

While caring for a patient in the intensive care unit, when should the nurse plan to conduct the square wave test on the patient's arterial pressure monitoring system? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
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

Question 27

The nurse is planning to assess the blood pressure of a patient with a BMI of 40. Which approaches should the nurse use to correctly obtain this patient's blood pressure? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Use a cuff with a bladder that is 80% of the patient's arm circumference.
2) Use a thigh cuff.
3) Use an adult cuff on the patient's forearm.
4) Assess the blood pressure using the same approach each time.
5) Use an adult cuff on the patient's thigh.

Question 28

The nurse suspects that a patient is experiencing cardiogenic shock. Which parameter indicates that the nurse's suspicion is correct?
1) Cardiac output of 8.9 L/min
2) Pulmonary artery wedge pressure (PAWP) of 8 mm Hg
3) Central venous pressure (CVP) of 5 mm Hg
4) Cardiac index (CI) of 1.8 L/min/m²

Question 29

Prior to the insertion of an arterial line in the radial artery, which assessment should the nurse perform?
1) Homan's test
2) Kernig's test
3) Allen's test
4) Leopold's maneuver

Question 30

When observing the waveform of an arterial line, the nurse notes the presence of a dicrotic notch. How should the nurse interpret this finding?
1) Pulmonic valve opening
2) Mitral valve closure
3) Aortic valve closure
4) Tricuspid valve closure

Question 31

A patient demonstrates signs of elevated pulmonary vascular resistance (PVR). For which health problem should the nurse assess this patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Hypoxia
2) Aortic stenosis
3) Pulmonary stenosis
4) Pulmonary embolism
5) Pulmonary hypertension

Question 32

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. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Pericardial tamponade
2) Constrictive pericarditis
3) Hypovolemia
4) Neurogenic shock
5) Mitral stenosis

Question 33

The nurse is concerned that a patient's pulmonary artery catheter has slipped into the right ventricle. What are the hallmarks of the waveform that the nurse observes on the monitor? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
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

Question 34

A patient has a pressure-monitoring device inserted after an acute myocardial infarction. Which action should the nurse take to minimize the risk of overdampened measurements? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Ensure tubing is without kinks.
2) Add tubing to the flush system.
3) Remove all air from the flush system.
4) Inflate the pressure bag to 300 mm Hg.
5) Maintain adequate normal saline in the flush bag.

Question 35

The nurse wants to assess the oxygenation status of a patient who has been experiencing a gastrointestinal bleed. How should the nurse complete this assessment? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Use pulse oximetry.
2) Send a blood sample for arterial blood gas analysis.
3) Auscultate lung sounds.
4) Evaluate cardiac rhythm strip.
5) Calculate mean arterial pressure.

Question 36

A patient with a PA catheter needs PCWP readings every 4 hours. What technique should the nurse follow when obtaining these pressures?
1) Cap the port after the balloon is inflated.
2) Keep the balloon inflated for 30 seconds.
3) Inflate the balloon until the PA waveform changes.
4) Open the balloon inflation valve after each measurement.