INTRODUCTION TO CRITICAL CARE NURSING 7TH EDITION SOLE TEST BANK
Chapter 08: Hemodynamic Monitoring
Sole: Introduction to Critical Care Nursing, 7th Edition
MULTIPLE CHOICE
1. The nurse is caring for a 100-kg patient being monitored with a pulmonary artery catheter.
The nurse assesses a blood pressure of 90/60 mm Hg, heart rate 110 beats/min, respirations
36/min, oxygen saturation of 89% on 3 L of oxygen via nasal cannula. Bilateral crackles are
audible upon auscultation. Which hemodynamic value requires immediate action by the
nurse?
a. Cardiac index (CI) of 1.2 L/min/m3
b. Cardiac output (CO) of 4 L/min
c. Pulmonary vascular resistance (PVR) of 80 dynes/sec/cm–5
d. Systemic vascular resistance (SVR) of 1400 dynes/sec/cm–5
ANS: A
A cardiac index of 1.2 L/min/m3 combined with the identified clinical assessment findings
indicate a low cardiac output with fluid overload (bilateral crackles), requiring intervention.
The remaining hemodynamic values are within normal limits: cardiac output of 4 L/min;
pulmonary vascular resistance of 80 dynes/sec/cm–5; and the systemic vascular resistance of
1400 dynes/sec/cm–5.
DIF: Cognitive Level: Analyze/Analysis REF: p. 137 | Table 8-1 | Box 8-8
OBJ: Identify normal hemodynamic values.
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs CategoN ryU: R
PShIyNsiGoTloBg.iCcO
alMIntegrity
2. While caring for a patient with a small bowel obstruction, the nurse assesses a pulmonary
artery occlusion pressure (PAOP) of 1 mm Hg and hourly urine output of 5 mL. The nurse
anticipates which therapeutic intervention?
a. Diuretics
b. Intravenous fluids
c. Negative inotropic agents
d. Vasopressors
ANS: B
Low pulmonary artery occlusion pressures usually indicate volume depletion, so intravenous
fluids would be indicated. A normal hourly urine output is 1 mL/kg or at least 30 mL/hour, so
this is another indication that the patient is volume depleted. Administration of diuretics
would worsen the patient’s volume status. Negative inotropes would not improve the patient’s
volume status. Vasopressors will increase blood pressure but are contraindicated in a low
volume state.
DIF: Cognitive Level: Analyze/Analysis REF: p. 149 | Box 8-1
OBJ: Articulate appropriate nursing actions for patients with altered hemodynamic values.
TOP: Nursing Process Step: Planning
MSC: NCLEX Client Needs Category: Physiological Integrity
, INTRODUCTION TO CRITICAL CARE NURSING 7TH EDITION SOLE TEST BANK
3. The nurse is caring for a patient who has had an arterial line inserted. To reduce the risk of
complications, what is the priority nursing intervention?
a. Apply a pressure dressing to the insertion site.
b. Ensure that all tubing connections are tightened.
c. Obtain a portable x-ray to confirm placement.
d. Restrain the affected extremity for 24 hours.
ANS: B
Loose connections in hemodynamic monitoring tubing can lead to hemorrhage, a major
complication of arterial pressure monitoring. Application of a pressure dressing is required
only upon arterial line removal. Blood return is adequate confirmation of arterial line
placement; radiography is not performed to confirm arterial line placement. Neutral
positioning of the extremity and use of an arm board, without limb restraint, is the standard of
care.
DIF: Cognitive Level: Apply/Application REF: p. 144
OBJ: Describe the indications, measurement, complications, and nursing implications associated with
monitoring of invasive right atrial, left atrial, pulmonary artery, and intraarterial pressures and those
equated with noninvasive monitoring of hemodynamic indices.
TOP: Nursing Process Step: Intervention
MSC: NCLEX Client Needs Category: Physiological Integrity
4. While caring for a patient with a pulmonary artery catheter, the nurse notes the pulmonary
artery occlusion pressure (PAOP) to be significantly higher than previously recorded values.
The nurse assesses respirations to be unlabored at 16 breaths/min, oxygen saturation of 98%
on 3 L of oxygen via nasal cannula, and lungs clear to auscultation bilaterally. What is the
priority nursing action?
a. Increase supplemental oxygenNaUnRdSnINotGifTyBr.CesOpMiratory therapy.
b. Notify the provider immediately of the assessment findings.
c. Obtain a stat chest x-ray film to verify proper catheter placement.
d. Zero reference and level the catheter at the phlebostatic axis.
ANS: D
A hemodynamic value not supported by clinical assessment should be treated as questionable.
To ensure the accuracy of hemodynamic readings, the catheter transducer system must be
leveled at the phlebostatic axis and zero referenced. In this example, the catheter transducer
system may be lower than the phlebostatic axis, resulting in erroneously higher pressures.
Clinical manifestations do not support increasing supplemental oxygen. Clinical
manifestations do not warrant provider intervention; aberrant values should be investigated
further. An aberrant value warrants further investigation, which includes zero referencing and
checking the level as an initial measure. A chest x-ray study is not warranted at this time.
DIF: Cognitive Level: Analyze/Analysis REF: pp. 140-141
OBJ: Analyze conditions that alter hemodynamic values.
TOP: Nursing Process Step: Intervention
MSC: NCLEX Client Needs Category: Physiological Integrity
, INTRODUCTION TO CRITICAL CARE NURSING 7TH EDITION SOLE TEST BANK
5. A patient is admitted to the hospital with multiple trauma and extensive blood loss. The nurse
assesses vital signs to be BP 80/50 mm Hg, heart rate 135 beats/min, respirations 36
breaths/min, cardiac output (CO) of 2 L/min, systemic vascular resistance of 3000
dynes/sec/cm–5, and a hematocrit of 20%. The nurse anticipates administration of which the
following therapies or medications?
a. Blood transfusion
b. Furosemide
c. Dobutamine infusion
d. Dopamine hydrochloride infusion
ANS: A
Both hemodynamic parameters and the reported hematocrit value indicate hypovolemia and
blood loss requiring volume resuscitation with blood products. Furosemide administration will
worsen fluid volume status. Inotropic agents will not correct the underlying fluid volume
deficit and anemia. Vasoconstrictors are contraindicated in a volume-depleted state.
DIF: Cognitive Level: Analyze/Analysis REF: p. 137 | Table 8-1 | Box 8-8
OBJ: Articulate appropriate nursing actions for patients with altered hemodynamic values.
TOP: Nursing Process Step: Planning
MSC: NCLEX Client Needs Category: Physiological Integrity
6. After pulmonary artery catheter insertion, the nurse assesses a pulmonary artery pressure of
45/25 mm Hg, a pulmonary artery occlusion pressure (PAOP) of 20 mm Hg, a cardiac output
of 2.6 L/min and a cardiac index of 1.9 L/min/m2. Which provider order is of the highest
priority?
a. Apply 50% oxygen via Venturi mask.
b. Insert an indwelling urinary catheter.
NURSINGTB.COM
c. Begin a dobutamine infusion.
d. Obtain stat cardiac enzymes and troponin.
ANS: C
The pulmonary pressures are higher than normal, indicating elevated preload, and the cardiac
index and output values are low. The priority order for the nurse to implement is to begin a
dobutamine infusion to improve cardiac output, possibly reducing pulmonary artery occlusion
pressures. The other treatments may be important, depending on other patient data, but the
dobutamine infusion is the most important at this time.
DIF: Cognitive Level: Analyze/Analysis REF: p. 150 | Box 8-8
OBJ: Articulate appropriate nursing actions for patients with altered hemodynamic values.
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
7. The nurse is caring for a patient with a left subclavian central venous catheter (CVC) and a
left radial arterial line. Which assessment finding by the nurse requires immediate action?
a. A dampened arterial line waveform
b. Numbness and tingling in the left hand
c. Slight bloody drainage at subclavian insertion site
d. Slight redness at subclavian insertion site
ANS: B
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