Deck 31: Hemodynamic Monitoring

Question 1

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?

A) "What you are seeing is called a dicrotic notch, and it means the beginning of the resting phase of your heart."
B) "It is nothing for you to be concerned about. It is just a measurement of your blood pressure."
C) "You are right. I will see if you are prescribed any medication for that problem."
D) "You are seeing the strongest part of your heart muscle, which is the first number of a blood pressure reading."

Answer 1

"What you are seeing is called a dicrotic notch, and it means the beginning of the resting phase of your heart."

Question 2

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

A) Turn the stopcock closest to the patient to the neutral position.
B) Zero the transducer.
C) Increase the arterial line infusion to 5 mL/hour.
D) Prime the transducer system.

Answer 2

Zero the transducer.

Question 3

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

A) Fourth intercostal space, halfway between the left anterior and posterior chest walls
B) Fifth intercostal space, midclavicular line
C) Second intercostal space at the anterior chest wall
D) Right side of sternum just below the sternal notch

Answer 3

Fourth intercostal space, halfway between the left anterior and posterior chest walls

Question 4

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?

A) When inflated, the catheter indirectly measures pressures in the left side of the heart.
B) When inflated, the catheter measures the pressure in the right side of the heart.
C) When inflated, the catheter indirectly measures the cardiac index.
D) When inflated, the catheter measures cardiac output through thermodilution.

Question 5

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?

A) "Data from hemodynamic monitoring can be used to evaluate the patient's progress."
B) "Hemodynamic monitoring data can help to guide fluid administration and prevent fluid overload."
C) "Hemodynamic monitoring data can be used to aid in the diagnosis of lung disorders."
D) "One drawback of hemodynamic monitoring is that the catheter must go through the heart and into the pulmonary artery."

Question 6

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?

A) Report this finding immediately; the patient may need another chest X-ray to check for placement.
B) Flush the ports.
C) Obtain a pulmonary artery occlusion pressure.
D) Zero balance the system.

Question 7

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 20/8. What assessment can the nurse make from this data?

A) The patient may require additional fluids because all pressures are low.
B) The pressure in the lungs is high even though the other pressures are low. The doctor should be notified and stat X-ray expected.
C) The patient is stable and should continue to be monitored hourly because of the sepsis.
D) The line should be flushed and rezeroed before an evaluation can be made.

Question 8

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?

A) Administering magnesium sulfate
B) Encouraging the patient to exercise
C) Giving the patient a beta-adrenergic blocking medication
D) Correcting oxygenation and mild respiratory acidosis

Question 9

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

A) It is not a good idea to measure the patient's blood pressure from the arterial waveform tracing.
B) The pressures in the superior and inferior vena cava are lower than the pressure in the right atrium of the heart.
C) The normal pressure in the right atrium of the heart is very low, 4 to 6 mmHg.
D) The small vessels of the pulmonary arteries are under more pressure than systemic arterial blood pressure.

Question 10

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

A) Prevent infection at the catheter site by changing the dressing as prescribed.
B) Set alarm limits and turn monitor alarms on.
C) Explain to family members why the monitoring is in use.
D) Coil IV tubing on the bed.

Question 11

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?

A) If afterload is high, cardiac output will be increased because the heart rate increases during afterload.
B) If afterload is high, cardiac output will be increased due to the increased volume in the heart.
C) If afterload is high, cardiac output will be decreased due to high systemic vascular resistance.
D) If afterload is high, cardiac output will be decreased due to decreased contractility.

Question 12

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?

A) Obtain a blood pressure in the left arm.
B) Try to obtain a pulse using Doppler ultrasound.
C) Notify the physician stat.
D) Flush the arterial catheter and zero the line.

Question 13

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

A) Changing the dosages titrating) of medications based on changes in hemodynamic pressures
B) Using sterile technique to clean the site of insertion of the catheter and changing the dressing
C) Inflating the balloon in the pulmonary artery to obtain pulmonary artery occlusion pressures
D) Advancing the catheter if the radiologist determines it is not in the pulmonary artery

Question 14

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?

A) Provide plasma.
B) Provide intravenous fluids.
C) Provide diuretic therapy as prescribed.
D) Encourage an increase in fluids by mouth.

Question 15

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

A) The blood pressure within the right atrium
B) The blood pressure within the pulmonary artery
C) The blood pressure within the left ventricle
D) The blood pressure within the left atrium

Question 16

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

A) Cannot tolerate hemodynamic monitoring
B) Requires a peripheral intravenous catheter for vasoactive medication administration
C) Needs a central catheter for total parenteral nutrition
D) Requires evaluation of left ventricular pressures each shift

Question 17

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?

A) Arterial pressure monitoring
B) Pulmonary artery pressure monitoring
C) Central venous pressure monitoring
D) Intra-aortic balloon pump monitoring

Question 18

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

A) It is better to look at current numbers for central venous pressure monitoring rather than trends.
B) Central venous pressure is a direct measurement of systemic vascular resistance.
C) A decreasing trend in central venous pressure may indicate right heart failure.
D) An increasing trend in central venous pressure may result from fluid building in the lungs.

Question 19

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?

A) "The hemodynamic monitor can measure how much blood is in the arteries and veins."
B) "The hemodynamic monitor can measure how much blood comes out of the heart each minute."
C) "The hemodynamic monitor can measure how much oxygen is left in the blood after it circulates through the body."
D) "The hemodynamic monitor can measure how much pressure is in the heart."

Question 20

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

A) Keeping IV solutions at atmospheric pressure so the monitor obtains accurate patient pressures
B) Frequent reassessment and evaluation of data in order to tailor therapies to the patient
C) Using the hemodynamic line for monitoring pressures and not for infusing IV fluids
D) Zero referencing the transducer to the level of the radial artery

Question 21

The nurse educator is discussing hemodynamic monitoring with newly hired intensive care unit nurses. Which information regarding the importance of leveling the hemodynamic transducer should the educator provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) The level of the transducer is set when the central venous catheter is initiated and should not be moved.
B) If the transducer is too high, pressure readings will be decreased.
C) The physician must be called in to level the transducer.
D) The transducer should be leveled with the phlebostatic axis point.
E) It the transducer is too low, the readings will be increased.

Question 22

The nurse wishes to calculate a patient's cardiac index. Which patient information will the nurse require for this calculation? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Age
B) Weight
C) Temperature
D) Height
E) Cardiac output

Question 23

The patient has been X-rayed after insertion of a pulmonary artery catheter PAC). Which components of this system would the nurse expect to see in the right atrium? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) The proximal port
B) The thermistor
C) The proximal injectate port
D) The transducer
E) The balloon

Question 24

Which findings would suggest to the nurse that the balloon of a pulmonary artery catheter PAC) has ruptured? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) No pulmonary artery occlusion pressure tracing appears when the balloon is inflated.
B) Blood is noted in the air inflation port.
C) It is not possible to pull air back out of the balloon with the syringe.
D) A right bundle branch block appears on the electrocardiogram tracing.
E) The normal pulmonary artery waveform does not return after obtaining the pulmonary artery occlusion pressure.

Question 25

Which actions are correct when the nurse is performing the Allen's test? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Occlude the radial artery and, after 15 seconds, occlude the ulnar artery.
B) Ask the patient to hold the hand below waist level for 30 seconds before beginning the test.
C) Release pressure over the ulnar artery first.
D) Hold pressure on the radial artery for 30 seconds before assessing the hand.
E) Consider color return to the hand in 20 seconds as a negative test.

Question 26

The patient is experiencing premature ventricular contractions PVCs) every other beat of the cardiac rhythm. The nurse would expect which effect on the patient's cardiac output?

A) The cardiac output will be doubled.
B) There will be little if any effect on cardiac output.
C) Cardiac output will be markedly reduced.
D) Cardiac output will be reduced with normal beats and increased with PVCs.

Question 27

A patient's vital signs are heart rate 82, respirations 22, and blood pressure 90/5
2) If hemodynamic monitoring reveals the patient's cardiac output to be 5330 mL/min, the nurse would calculate that stroke volume is _____ mL.

Question 28

Which finding would suggest to the nurse that the patient has a good cardiac reserve?

A) The patient is able to tolerate a gradual increase of pace during a treadmill exam.
B) The patient breathes in through the nose and out through the mouth when sitting quietly.
C) After cardiac rehabilitation exercises the patient sits in a chair to cool down.
D) The patient complains of pain in the legs after walking 100 yards.

Question 29

The nurse would discard any cardiac output measurement obtained from a pulmonary artery catheter if the measurement was questionable based on the curve or if two measurements differed by _____ %.

Question 30

The nurse is obtaining a thermodilution cardiac output measurement from a pulmonary artery catheter PAC). Which techniques should the nurse use? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Keep the injectate at least 10°F below room temperature.
B) Inject the injectate over 30-45 seconds.
C) Inject the injectate smoothly.
D) Inject the standard amount of injectate for the brand of catheter.
E) Perform three measurements 1 to 2 minutes apart.

Question 31

The nurse is assisting with the insertion of a subclavian central venous catheter. Which actions are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Place the patient in a prone position.
B) Ask the patient to turn the head away from the insertion site.
C) Alert the patient that the face may be covered temporarily with sterile drapes.
D) Place the bed in Trendelenburg position.
E) Ask the patient to cough when feeling the insertion catheter touch the skin.

Question 32

Which nursing instruction is given to the patient whose central venous catheter will be removed?

A) "Take a deep breath."
B) "Roll over to your left side."
C) "Use this gauze to apply pressure over the insertion site."
D) "Place your hand over your head as I remove this line."

Question 33

During insertion of a subclavian central venous catheter, the patient reports chest pain. Vital signs reveal hypotension and tachypnea. Upon inspection, the patient appears dyspneic and cyanotic. The nurse would assess for which conditions? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Pneumothorax
B) Air embolism
C) Perforation of the left ventricle
D) Stroke
E) Fluid volume overload

Question 34

Which actions would the nurse take when removing a radial artery catheter? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Don a sterile gown, sterile gloves, and eye protection.
B) Send the tip of the catheter to the laboratory for culture and sensitivity.
C) Remove the dressing.
D) Apply direct pressure to the insertion site after the catheter is removed.
E) Plan frequent observation of the site after removal of the catheter.

Question 35

A critically ill patient is admitted for the treatment of pneumonia and is receiving mechanical ventilation. The central venous pressure CVP) is 15, and the pulmonary arterial pressure PAP) is 55/3

A) Both pressures are low because the patient has increased fluid volume and may be septic from the pneumonia.
B) The CVP is low because the patient has increased fluid volume, and the high PAP indicates increased pressure in the lungs.
C) Both pressures are high, indicating that the patient has increased pressure in the lungs and a high fluid volume.
D) The CVP is high, indicating increased fluid volume, and the low PAP indicates impending heart failure.
E) What evaluation can the nurse make from this data?