HLTH 103 PASSPOINT HEMODYNAMIC QUIZ
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 press...
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
, HLTH 103 PASSPOINT HEMODYNAMIC QUIZ
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
, HLTH 103 PASSPOINT HEMODYNAMIC QUIZ
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:
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