Hemodynamic NCLEX Questions:
1. A client in the ICU has an abnormal pulmonary artery wedge pressure. What should the
nurse do? Retake the measurement and Look at this finding in relation to other
measurements.
2. The nurse has just measured a client's cardiac output using the thermodilution method.
The findings show a notched, uneven curve. What should the nurse do with these results?
Repeat the measurement. A small curve indicates a high CO, a large curve indicates a low
CO, and a notched or uneven curve indicates a poor injection technique and should be
repeated.
3. A client is having a continuous cardiac output pulmonary artery catheter placed. Which of
the following would be indicated for this client? The cardiac output measurements will
change according to the measuring device's findings and the findings from this catheter
are consistently accurate.
4. The nurse is planning the care for a client with an elevated right atrial pressure. Which of
the following should be included in this plan of care? Administer vasodilating medications
as prescribed and Monitor intake and output. Care is directed toward optimizing preload by
reducing volume. Overall goals are to decrease venous return to the right heart, increase
contractility, and decrease the workload of the heart. Preload can be reduced by fluid and
sodium restrictions and the administration of diuretics or vasodilating medications.
Nursing care should include intake and output, daily weights, dietary consult for any
restrictions, and medication teaching to enhance adherence.
5. During the review of a client's hemodynamic measurements the nurse sees a right
ventricular waveform. What should the nurse do for this client? Notify the physician for
repositioning.
6. While monitoring a client's pulmonary artery pressure the nurse sees a distinct notch in
the waveform. What should the nurse do about this finding? Nothing. This is a normal
finding. The pulmonary artery waveform has a characteristic pattern consisting of a steep
upstroke and a downstroke that is distinguished by a dicrotic notch formed by the closure
of the pulmonic valve.
7. The nurse is planning the care of a client with an elevated pulmonary artery systolic
pressure. What should be included in this plan of care? Administer diuretics as prescribed
and Monitor intake and output. Interventions are determined by the cause. Reduce preload
by administering diuretcs and imposing fluid and sodium restrictions. The use of inotropic
medications might be prescribed. An intraaortic balloon pump might be indicated. Nursing
care should also include measuring intake and output and daily weights. Activities should
be planned around rest periods.
8. A client in the ICU has an elevated pulmonary artery wedge pressure. What should be
included in this client's plan of care? Monitor intake and output. Interventions are directed
toward optimizing preload by administering diuretics, vasodilators, nitrates, ACE inhibitors,
and inotropics. Sodium and fluid restrictions are also indicated. Also, intake and output and
daily weights should be measured. Activities should be limited and paced to the client's
tolerance level.
9. A client has a systemic arterial blood pressure monitor. Which of the following should be
included in the plan of care for this client? Monitor the site for infection. Secure the
pressure tubing to prevent dislodgement and possible exsanguinations. Monitor circulation
distal to the insertion site. Monitor the site for infection. Arterial line blood pressures
compared with noninvasive blood pressures do not always agree.
10. Explain how a pulmonary artery catheter will help the nurses and physicians plan
interventions to enhance cardiac functioning. Define CO. What is the equation for
determining CO? What measurement references CO to size? Elevation of which of the
hemodynamic readings would indicate left-sided failure with no right-sided pathology?
Briefly describe the function of the arterial line.
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, EKG NCLEX Questions:
1. A client in the ICU is prescribed Calan (verapamil), a calcium channel blocker. The nurse
knows that this medication will affect cardiac membrane permeability, specifically during:
Phase 2. During the second phase, calcium moves into the cell or the calcium channels
open. A calcium channel blocker will reduce this influx of calcium.
2. A client in the ICU is on continuous cardiac monitoring. Which of the following should be
included in the plan of care for this client? Explain to the client that there is a low risk of
shock from the electrodes and Change the location of electrodes after daily bathing.
Nursing actions include preparing the client's chest wall for electrode placement, the need
to rotate electrode sites, setting alarms, documenting the ECG in the medical record, client
teaching about the monitor, findings, and alarms.
3. A client in the ICU has fluid volume overload and hypokalemia. Which of the following
might be seen on this client's ECG? Lengthened QT interval and Presence of a U wave.
With hypokalemia, the PR interval may be longer, the T wave may be flat, the QT interval
may lengthen, an extra wave may follow the T wave (U wave), and PVCs may occur. Fluid
volume overload may result in ventricular enlargement and decreased contractility leading
to premature beats, cardiac conduction blocks, and an abnormal heart rate
4. A client in the ICU has been diagnosed with superventricular tachycardia. Which of the
following might be done to help this client? Prepare to administer adenosine and Coach
the client in the Valsalva maneuver. Treatment strategies include adenosine, beta-blocking
agents, calcium channel blockers, digitalis, cardioversion, and overdrive pacing. If the
client is asymptomatic, drug therapy is initiated to slow the rate. It may also be treated
with the Valsalva maneuver.
5. A client in the ICU is demonstrating PVCs on his ECG rhythm. Which of the following should
the nurse do to assist this client? Study the client's underlying cardiac rhythm. Determine
factors that contribute to the occurrence of PVCs. Ischemia is a cause of PVCs. Hypoxia,
acidosis, hypokalemia, and digitalis toxicity are all associated with PVCs. Not all PVCs are
treated. Lidocaine may be administered. Amiodarone or proncainamide may be
administered if lidocaine doesn't work. The underlying cardiac rhythm needs to be
assessed along with the type of PVCs. The timing and pattern are also assessed.
6. A client in the ICU continues to demonstrate PVCs on his ECG rhythm. The nurse knows the
medications commonly used to treat this type of dysrhythmia include: Treatment of PVCs
includes the administration of class IA, IB, and IC medications.
7. A client is going to undergo cardioversion. Which of the following should be included in the
care of this client? Provide a sedative prior to the procedure. The nurse assists with
cardioversion by obtaining an ECG strip prior to, during, and after the procedure. Informed
consent is obtained and IV access is confirmed before the procedure. Provide a sedative to
the client prior to the procedure to minimize discomfort. Report any electrolyte imbalances
to the physician. Remove all jewelry, oxygen, or other metallic objects from the client.
Place conductive pads on the client. Assess after the procedure for emboli, respiratory
depression, skin burns, or dysrhythmias.
8. The nurse is preparing to instruct a client about the implantable cardioverter/defibrillator.
Which of the following should be included in this instruction? Instruct to obtain a medic
alert bracelet. Client education is extensive and is to include the difference between a
heart attack and cardiac arrest. Also, the client should keep a log and be advised of when
to contact the physician. Clients with this device need to avoid high magnetic fields
because this might activate the device. Cell phones can interfere with the operation of all
defibrillators if held closer than 6 inches from the pulse generator. Instruct to keep a copy
of their ECG, device model number, and obtain a medic alert bracelet.
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