PassPoint Hemodynamic Quiz QUESTION 1 A client has had a pulmonary artery catheter inserted. In performing hemodynamic monitoring with the catheter, the nurse will wedge the catheter to gain informa tion about: You Selected: • left end-diastolic pressure. Explanation: When wedged, the catheter is...
PassPoint Hemodynamic Quiz
QUESTION 1
A client has had a pulmonary artery catheter inserted. In performing hemodynamic monitoring
with the catheter, the nurse will wedge the catheter to gain information about:
You Selected:
• left end-diastolic pressure.
Explanation:
When wedged, the catheter is “pointing” indirectly at the left end-diastolic pressure. The
pulmonary artery wedge pressure is measured when the tip of the catheter is slowing inflated and
allowed to wedge into a branch of the pulmonary artery. Once the balloon is wedged, the catheter
reads the pressure in front of the balloon. During diastole, the mitral valve is open, reflecting left
ventricular end diastolic pressure. Cardiac output is the amount of blood ejected by the heart in 1
minute and is determined through thermodilution and not wedge pressure. Cardiac index is
calculated by dividing the client’s cardiac output by the client’s body surface area, and is
considered a more accurate reflection of the individual client’s cardiac output. Right atrial blood
pressure is not measured with the pulmonary artery catheter.
QUESTION 2
A postpartum clinic nurse is assessing a client 4 weeks postpartum after a vaginal birth. Which of
the following assessments would indicate to the nurse that the client is experiencing normal
hemodynamic changes occurring in the postpartum period?
You Selected:
• The hematocrit rises from 34% to 40%.
Explanation:
Hemoglobin and erythrocyte values vary during the early postpartum period, but they should
approximate or exceed prelabor values within 2 to 6 weeks. As extracellular fluid is excreted,
hemoconcentration occurs, with a concomitant rise in hematocrit. Puerperal bradycardia with
rates of 50 to 70 beats per minute commonly occurs during the first 6 to 10 days of the postpartal
period. A client can experience orthostatic hypotension due to blood volume decreases following
placental separation, contraction of the uterus, and increased stroke volume. Cardiac output
begins to increase early in pregnancy and peaks at 20 to 24 weeks gestation at 30% to 50% above
prepregnant levels. Cardiac output decreases during the postpartum period following placental
separation, contraction of the uterus, and increased stroke volume.
QUESTION 3
A client admitted for a myocardial infarction (MI) develops cardiogenic shock. An arterial line is
inserted. Which prescription from the health care provider should the nurse verify before
implementing?
You Selected:
• Administer metoprolol 5 mg IV push.
Explanation:
Metoprolol is indicated in the treatment of hemodynamically stable clients with an acute MI to
reduce cardiovascular mortality. Cardiogenic shock causes severe hemodynamic instability and a
,beta blocker will further depress myocardial contractility. The metoprolol should be
discontinued. The decrease in cardiac output will impair perfusion to the kidneys. Cardiac
output, hemodynamic measurements, and appropriate interventions can be determined with a PA
catheter. Dobutamine will improve contractility and increase the cardiac output that is depressed
in cardiogenic shock.
QUESTION 4
A client is receiving dopamine hydrochloride for treatment of shock. What action should the
nurse take?
You Selected:
• Monitor blood pressure continuously.
Explanation:
The client who is receiving dopamine hydrochloride requires continuous blood pressure
monitoring with an invasive or noninvasive device. The nurse may titrate the IV infusion to
maintain a systolic blood pressure of 90 mm Hg. Administration of a pain medication
concurrently with dopamine hydrochloride, which is a potent sympathomimetic with dose-
related alpha-adrenergic agonist, beta 1-selective adrenergic agonist, and dopaminergic blocking
effects, is not an essential nursing action for a client who is in shock with already low
hemodynamic values. Arterial blood gas concentrations should be monitored according to the
client’s respiratory status and acid-base balance status and are not directly related to the
dopamine hydrochloride dosage. Monitoring for signs of infection is not related to the nursing
action for the client receiving dopamine hydrochloride.
QUESTION 5
A pulmonary artery catheter is inserted in a client with severe mitral stenosis and regurgitation.
The nurse administers furosemide to treat pulmonary congestion and begins a nitroprusside drip
as prescribed. The nurse notices a sudden drop in the pulmonary artery diastolic pressure and
pulmonary artery wedge pressure. The nurse should first assess:
You Selected:
• 12-lead EKG.
Correct response:
• blood pressure.
Explanation:
The nurse should immediately assess the blood pressure since nitroprusside and furosemide can
cause severe hypotension from a decrease in preload and afterload. If the client is hypotensive,
the nitroprusside dose should be reduced or discontinued. Urine output should then be monitored
to make sure there is adequate renal perfusion. A 12-lead EKG is performed if the client
experiences chest pain. A reduction in pulmonary artery pressures should improve the pulmonary
congestion and lung sounds.
QUESTION 6
Following a left anterior myocardial infarction, a client undergoes insertion of a pulmonary
artery catheter. Which finding most strongly suggests left-sided heart failure?
You Selected:
• Increased pulmonary artery diastolic pressure
, Explanation:
Increased pulmonary artery diastolic pressure suggests left-sided heart failure. Central venous
pressure increases in heart failure rather than decreases. The cardiac index decreases in heart
failure. The mean pulmonary artery pressure increases in heart failure.
QUESTION 7
A client with a history of myocardial infarction is admitted with shortness of breath, anxiety, and
slight confusion. Assessment findings include a regular heart rate of 120 beats/minute, audible
third and fourth heart sounds, blood pressure of 84/64 mm Hg, bibasilar crackles on lung
auscultation, and a urine output of 5 ml over the past hour. The nurse anticipates preparing the
client for transfer to the intensive care unit and pulmonary artery catheter insertion because:
You Selected:
• the client is going into cardiogenic shock.
Explanation:
This client's findings indicate cardiogenic shock, which occurs when the heart fails to pump
properly, impeding blood supply and oxygen flow to vital organs. Cardiogenic shock also may
cause cold, clammy skin and generalized weakness, fatigue, and muscle pain as poor blood flow
causes lactic acid to accumulate and prevents waste removal. Left-sided and right-sided heart
failure eventually cause venous congestion with jugular vein distention and edema as the heart
fails to pump blood forward. A ruptured aneurysm causes severe hypotension and a quickly
deteriorating clinical status from blood loss and circulatory collapse; this client has low but not
severely decreased blood pressure. Also, in ruptured aneurysm, deterioration is more rapid and
full cardiac arrest is common.
QUESTION 8
A client with a history of an anterior wall myocardial infarction is being transferred from the
coronary care unit (CCU) to the cardiac step-down unit (CSU). While giving a report to the CSU
nurse, the CCU nurse says, "His pulmonary artery wedge pressures have been in the high normal
range." The CSU nurse should be especially observant for:
You Selected:
• hypertension.
Correct response:
• pulmonary crackles.
Explanation:
High pulmonary artery wedge pressures are diagnostic for left-sided heart failure. With left-sided
heart failure, pulmonary edema can develop causing pulmonary crackles. In left-sided heart
failure, hypotension may result and urine output will decline. Dry mucous membranes aren't
directly associated with elevated pulmonary artery wedge pressures.
QUESTION 9
A client in the intensive care unit has an arterial line which reads 58/30 mm Hg on the monitor.
What is the nurse’s first action?
You Selected:
• Recalibrate the arterial line
Correct response:
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