Exam (elaborations)
Chapter 09_ Hemodynamic Monitoring.
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Chapter 09_ Hemodynamic Monitoring.
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Chapter 09: Hemodynamic MonitoringThe 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/cm5
d. Systemic vascular resistance (SVR) of 1800 dynes/sec/cm5 - correct answer-a. Cardiac
index (CI) of 1.2 L/min/m3
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 - correct answer-b. Intravenous fluids
The nursing 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 all tubing connections are tightened.
c. Obtain a portable x-ray to confirm placement.
d. Restrain the affected extremity for 24 hours. - correct answer-b. Ensure all tubing
connections are tightened.
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 oxygen and notify respiratory therapy.
b. Notify the physician 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. - correct answer-d. Zero
reference and level the catheter at the phlebostatic axis.
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/cm5, 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 - correct answer-a. Blood transfusion
The primary health care provider writes an order to discontinue a patient's left radial arterial
line. When discontinuing the patient's invasive line, what is the priority nursing action?
a. Apply an air occlusion dressing to insertion site.
b. Apply pressure to the insertion site for 5 minutes.
c. Elevate the affected limb on pillows for 24 hours.
d. Keep the patient's wrist in a neutral position. - correct answer-b. Apply pressure to the
insertion site for 5 minutes.
Following insertion of a central venous catheter, the nurse obtains a stat chest x-ray film to
verify proper catheter placement. The radiologist reports to the nurse: "The tip of the catheter
is located in the superior vena cava." What is the best interpretation of these results by the
nurse?
a. The catheter is not positioned correctly and should be removed.
b. The catheter position increases the risk of ventricular dysrhythmias.
c. The distal tip of the catheter is in the appropriate position.
d. The physician should be called to advance the catheter into the pulmonary artery. - correct
answer-c. The distal tip of the catheter is in the appropriate position.
The nurse is caring for a patient following insertion of a left subclavian central venous
catheter (CVC). Which assessment finding 2 hours after insertion by the nurse warrants
immediate action?
a. Diminished breath sounds over left lung field
b. Localized pain at catheter insertion site
c. Measured central venous pressure of 5 mm Hg
d. Slight bloody drainage around insertion site - correct answer-a. Diminished breath sounds
over left lung field
The nurse is caring for a mechanically ventilated patient with a pulmonary artery catheter
who is receiving continuous enteral tube feedings. When obtaining continuous hemodynamic
monitoring measurements, what is the best nursing action?
a. Do not document hemodynamic values until the patient can be placed in the supine
position.
b. Level and zero reference the air-fluid interface of the transducer with the patient in the
supine position and record hemodynamic values.
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