Preview Extract
Chapter 24
1. The nurse is orienting to care for patients in the intensive care area. Which of the following
statements indicates that the new nurse needs more information about hemodynamic
monitoring?
1. “One drawback of hemodynamic monitoring is that the catheter must go through the heart
and into the pulmonary artery.”
2. “Hemodynamic monitoring data can be used to aid in the diagnosis of lung disorders.”
3. “Hemodynamic monitoring data can help to guide fluid administration and prevent fluid
overload.”
4. “Data from hemodynamic monitoring can be used to evaluate the patient’s progress.”
Answer: “One drawback of hemodynamic monitoring is that the catheter must go through the
heart and into the pulmonary artery.”
Rationale:
The pulmonary artery catheter does go through the heart and into the pulmonary artery;
however, hemodynamic monitoring can also be accomplished through a peripheral arterial
line. The other answer choices are true and indicate that the nurse has a good understanding
of hemodynamic monitoring.
2. A family member of a critically ill patient is verbalizing the purpose of hemodynamic
monitoring. Which of the following statements indicates that the family member needs more
education?
1. “The hemodynamic monitor can measure how much blood is in the arteries and veins.”
2. “The hemodynamic monitor can measure how much oxygen is left in the blood after it
circulates through the body.”
3. “The hemodynamic monitor can measure how much pressure is in the heart.”
4. “The hemodynamic monitor can measure how much blood comes out of the heart each
minute.”
Answer: “The hemodynamic monitor can measure how much blood is in the arteries and
veins.”
Rationale:
The family member of the critically ill patient would need further teaching if he or she
thought the hemodynamic monitor could measure the volume of blood in the vascular system.
The pressure monitoring can see trends in pressure, which may indirectly be related to
volume or to decreased vascular resistance. The nurse and physician would need to interpret
this data to determine the cause of the change. The other answer choices are true and indicate
that the family member has a good understanding of hemodynamic monitoring.
3. A patient is concerned about the arterial line waveform pattern because there is a break in
the downward slope of the pattern and “something must be wrong” since it is not a smooth
line. Which of the following is the nurse’s best response to this patient?
1. “What you are seeing is called a dicrotic notch, and it means the beginning of the resting
phase of your heart.”
2. “You are right. I will see if you are prescribed any medication for that problem.”
3. “It is nothing for you to be concerned about. It is just a measurement of your blood
pressure.”
4. “You are seeing the strongest part of your heart muscle, which is the first number of a
blood pressure reading.”
Answer: “What you are seeing is called a dicrotic notch, and it means the beginning of the
resting phase of your heart.”
Rationale:
The dicrotic notch represents closure of the aortic valve and distinguishes the beginning of
diastole or the resting phase of the heart ventricles. The nurse should explain the notch to the
patient and that it means the beginning of the heart’s resting phase. The nurse should not
agree with the patient by saying that there is something wrong and that the patient might need
medication. The nurse should not minimize the patient’s concern. The dicrotic notch does not
signify systole or the first number of a blood pressure reading.
4. An important role of the nurse who is caring for a patient with an invasive hemodynamic
monitoring includes:
1. Frequent reassessment and evaluation of data in order to tailor therapies to the patient.
2. Keeping IV solutions at atmospheric pressure so the monitor accurately obtains patient
pressures.
3. Using the hemodynamic line for monitoring pressures and not for infusing IV fluids.
4. Zero referencing the transducer to the level of the radial artery.
Answer: Frequent reassessment and evaluation of data in order to tailor therapies to the
patient.
Rationale:
An important role of the nurse caring for a patient with an invasive hemodynamic monitoring
includes frequent reassessment and evaluation of data in order to tailor therapies to the
patient. Fluids and medications are often changed when the nurse reports changes in
hemodynamic data to the health care provider. IV solutions are kept at 300 mmHg. Fluids are
infused constantly through the system to prevent clotting of the line. The hemodynamic
transducer is zeroed using the phlebostatic axis as a reference.
5. The nurse is setting up hemodynamic monitoring. The purpose of the dynamic wave test,
also known as the square wave test, is to determine whether the:
1. Transducer is accurately reflecting pressure in the vessel.
2. Line is at the correct level to measure hemodynamic pressures.
3. Radial artery can be used for monitoring.
4. Hemodynamic line has the correct amount of pressure in it.
Answer: Transducer is accurately reflecting pressure in the vessel.
Rationale:
The purpose of the dynamic wave test, also known as the square wave test, is to determine
whether the transducer is accurately reflecting pressure in the vessel. The phlebostatic access
is used to determine the correct level to measure hemodynamic pressures. The Allen’s test is
used to measure whether the radial artery can be used for monitoring. The pressure should
remain relatively constant at 300 mmHg for accurate hemodynamic monitoring.
6. A patient with an arterial line has just been turned and repositioned. After leveling the
transducer, which of the following should the nurse do next?
1. Zero the transducer.
2. Fast flush the catheter.
3. Increase the arterial line infusion to 5 ml/hour.
4. Turn the stopcock closest to the patient to the on position.
Answer: Zero the transducer.
Rationale:
Zeroing the transducer should be done after turning the patient, once the transducer has been
leveled. Fast flushing the catheter is done to test whether the transducer is accurately
transmitting the pressure detected in the vessel. The arterial line infusion should be set at 1 to
3 ml/hour. Turning the stopcock closest to the patient to the on position is done after the
transducer has been zeroed.
7. When comparing arterial, central venous, and pulmonary arterial pressures, the nurse
knows that:
1. The normal pressure in the right atrium of the heart is very low, 2 to 6 mm/Hg.
2. The small vessels of the pulmonary arteries are under more pressure than systemic arterial
blood pressure.
3. It is not a good idea to measure the patient’s blood pressure from the arterial waveform
tracing.
4. The pressures in the superior and inferior vena cava are lower than the pressure in the right
atrium of the heart.
Answer: The normal pressure in the right atrium of the heart is very low, 2 to 6 mm/Hg.
Rationale:
The normal pressure in the right atrium of the heart is very low, 2 to 6 mm/Hg, and is equal to
the pressures in the superior and inferior vena cava because there is no valve between the
vena cava and the right atrium. Pulmonary arterial pressure is normally lower than systemic
arterial blood pressure. The arterial waveform tracing is an accurate way to measure blood
pressure as long as the blood pressure was measured accurately.
8. A critically ill patient is admitted for the treatment of sepsis. The right arterial BP is 90/60,
the central venous pressure is 2, and the pulmonary arterial pressure is 20/8. What assessment
can the nurse make from this data?
1. The patient may require additional fluids because all pressures are low.
2. The patient is stable and should continue to be monitored hourly due to the presence of
sepsis.
3. The pressure in the lungs is high even though the other pressures are low. The doctor
should be notified and STAT X-ray expected.
4. The pressure in the right atrium is 2, which is inaccurate. The line should be flushed and
re-zeroed before an evaluation can be made.
Answer: The patient may require additional fluids because all pressures are low.
Rationale:
The arterial, central venous, and pulmonary arterial pressures are all low. Sepsis is a type of
distributive shock. The nurse would expect to give a fluid bolus in this situation as well as
initiate or continue other therapies for sepsis.
9. The nurse reviewing the waveform of a patient’s central venous pressure line notes two
positive waves. Which of the following does this information suggest to the nurse?
1. The c wave is not always visible on the tracing.
2. The line is no longer in the correct position.
3. The wave is not visible during systole.
4. The wave is not visible during diastole.
Answer: The c wave is not always visible on the tracing.
Rationale:
The normal central venous pressure waveform has three positive waves. The a wave
correlates with systole. The c wave reflects retrograde swelling of the tricuspid valve into the
right atrium and may not be visible on the tracing. The v wave represents diastole. With the
presence of the other waves, the catheter is in the correct position in the patient.
10. The nurse is monitoring central venous pressure. Which statement is correct regarding
central venous monitoring?
1. An increasing trend in central venous pressure may result from fluid building in the lungs.
2. A decreasing trend in central venous pressure may indicate right heart failure.
3. It is better to look at current numbers for central venous pressure monitoring rather than
trends.
4. Central venous pressure is a direct measurement of systemic vascular resistance.
Answer: An increasing trend in central venous pressure may result from fluid building in the
lungs.
Rationale:
An increasing trend in central venous pressure may result from fluid building in the lungs. As
pressure in the lungs increases, volume in the right heart will increase, which will increase
the CVP. Right heart failure would also cause an increasing CVP. It is more accurate to look
at trends rather than one CVP reading. CVP is not a direct measurement of systemic vascular
resistance.
11. A nurse is preparing to inflate the balloon located in the pulmonary artery. What is the
purpose of inflating the balloon?
1. When inflated, the catheter indirectly measures pressures in the left side of the heart.
2. When inflated, the catheter measures cardiac output through thermodilution.
3. When inflated, the catheter measures the pressure in the right side of the heart.
4. When inflated, the catheter indirectly measures the cardiac index.
Answer: When inflated, the catheter indirectly measures pressures in the left side of the heart.
Rationale:
Inflating the balloon in the pulmonary artery catheter indirectly measures pressures in the left
side of the heart. Cardiac output is measured though a thermistor located within the catheter.
The cardiac index is a calculation of the cardiac output divided by the body surface area.
12. A patient’s central venous pressure reading is 8 mm Hg. The nurse realizes this reading
reflects which of the following?
1. The blood pressure within the right atrium
2. The blood pressure within the left atrium
3. The blood pressure within the pulmonary artery
4. The blood pressure within the left ventricle
Answer: The blood pressure within the right atrium
Rationale:
The central venous pressure reflects the blood pressure of the vena cava and the right atrium.
The other choices do not reflect the central venous pressure.
13. While caring for a patient with a pulmonary artery catheter, which of the following is not
within the scope of practice of the nurse?
1. Advancing the catheter if the radiologist determines it is not in the pulmonary artery
2. Inflating the balloon in the pulmonary artery to obtain pulmonary artery occlusion
pressures
3. Using sterile technique to clean the site of insertion of the catheter and changing the
dressing
4. Changing the dosages (titrating) of medications based on changes in hemodynamic
pressures
Answer: Advancing the catheter if the radiologist determines it is not in the pulmonary artery
Rationale:
The nurse does not advance the catheter through the heart. The nurse does inflate the balloon,
use sterile technique to change the dressing and clean the site, and change the dosages of
medications (titrate) based on the patient’s response to therapy.
14. While caring for a patient with a right radial arterial line, the nurse assesses that the right
fingers are cool, pale, and dusky. Which intervention would be important to do first?
1. Notify the physician STAT.
2. Flush the arterial catheter and zero the line.
3. Try to obtain a pulse using Doppler ultrasound.
4. Obtain a blood pressure in the left arm.
Answer: Notify the health care provider STAT.
Rationale:
The health care provider needs to be notified STAT and the line needs to be discontinued.
Symptoms including cool, pale, and dusky skin indicate arterial occlusion, and this is a
medical emergency. Loss of arterial circulation will cause loss of the limb distal to the
occlusion unless circulation can be restored. The remaining actions do not take priority over
notifying the health care provider.
15. While caring for a patient with a pulmonary arterial catheter, the nurse notes that the
number of centimeters of the catheter has decreased. Which of the following should be done
at this time?
1. Report this finding immediately; the patient may need another chest x-ray to check for
placement.
2. Flush the ports.
3. Zero balance the system.
4. Obtain a pulmonary artery occlusion pressure.
Answer: Report this finding immediately; the patient may need another chest x-ray to check
for placement.
Rationale:
The distance the catheter is inserted should be documented and serves as a reference to other
care providers. If the length changes, the change should be reported immediately because it
could mean that the catheter has advanced and could puncture a structure within the
vasculature. The other choices would be inappropriate for the nurse to do at this time.
16. The nurse is noticing an increasing afterload in a patient in the ICU. How does the
increasing afterload affect cardiac output?
1. If afterload is high, cardiac output will be deceased due to high systemic vascular
resistance.
2. If afterload is high, cardiac output will be increased due to the increased volume in the
heart.
3. If afterload is high, cardiac output will be deceased due to decreased contractility.
4. If afterload is high, cardiac output will be increased because the heart rate increases during
afterload.
Answer: If afterload is high, cardiac output will be deceased due to high systemic vascular
resistance.
Rationale:
Afterload measures the pressure that is needed to eject blood out of the heart. Systemic
vascular resistance is the main factor that affects afterload. High resistance impedes flow and
decreases cardiac output. Contractility may increase with high afterload to compensate for
low stroke volume, or it may decrease if the patient decompensates. Either way, decreased
contractility does not cause high afterload.
17. The nurse is attempting to increase contractility to improve cardiac output in a patient
with acute exacerbation of heart failure. Which of the following measures would be helpful to
improve cardiac contractility?
1. Correcting oxygenation and mild respiratory acidosis
2. Encouraging the patient to exercise
3. Administering magnesium sulfate
4. Giving the patient a beta-adrenergic blocking medication
Answer: Correcting oxygenation and mild respiratory acidosis
Rationale:
Achieving normal oxygenation and correcting acidosis will improve cardiac contractility.
Encouraging exercise in a patient with acute exacerbation of heart failure is an unsafe
intervention. Both magnesium (a smooth muscle relaxant) and beta-adrenergic blocking
medication would decrease cardiac contractility.
18. The nurse is providing care for a patient diagnosed with an increase in afterload and a
CVP reading of 7 mm Hg. Which of the following will be included in this patient’s plan of
care?
1. Provide diuretic therapy as prescribed.
2. Provide plasma.
3. Provide intravenous fluids.
4. Encourage an increase in fluids by mouth.
Answer: Provide diuretic therapy as prescribed.
Rationale:
Excessive preload is evidenced by a CVP reading of greater than 6 mm Hg. The patient has
excessive circulation, which strains the heart, increases the workload of the heart, and
increases myocardial oxygen demands. Diuretic therapy would be indicated for this patient.
Plasma, intravenous fluids, and oral fluids would all be indicated for a patient who is
diagnosed with a decrease in preload and hypovolemia.
19. When comparing pressures obtained from the central venous pressure (CVP) versus
pressures obtained from the pulmonary arterial pressure, the nurse knows that:
1. The CVP is expected to be a low pressure while the PAP is the highest pressure obtained in
the pulmonary artery catheter.
2. The CVP is expected to be the highest pressure obtained in the pulmonary artery catheter
while the PAP is expected to be a low pressure.
3. The CVP and the PAP pressures cannot be compared because these pressures are based on
individual patients and their conditions.
4. The individual pressures obtained in the CVP and the PAP are not relevant. The pressure
trends guide patient care.
Answer: The CVP is expected to be a low pressure while the PAP is the highest pressure
obtained in the pulmonary artery catheter.
Rationale:
The CVP is expected to be a low pressure while the PAP is the highest pressure obtained in
the pulmonary artery catheter. Normal CVP readings vary from 2 to 6 mmHg, and normal
PAP pressures vary from 20 to 30 mmHg systolic, and 0 to 8 mmHg diastolic. While pressure
readings do vary between individuals, there are expected norms for the CVP and PAP.
Individual pressures ARE relevant, but it is also true that trends are used to guide patient care.
20. A critically ill patient is admitted for the treatment of pneumonia and is receiving
mechanical ventilation. The central venous pressure (CVP) is 15, and the pulmonary arterial
pressure (PAP) is 55/35. What evaluation can the nurse make from this data?
1. Since both pressures are high, the patient has increased pressure in the lungs and also has a
high fluid volume.
2. Since the CVP is high, the patient has increased fluid volume, and the low PAP indicates
impending heart failure.
3. The CVP is low because the patient has increased fluid volume, and the high PAP indicates
increased pressure in the lungs.
4. Both pressures are low because the patient has increased fluid volume, and may be septic
from the pneumonia.
Answer: Since both pressures are high, the patient has increased pressure in the lungs and
also has a high fluid volume.
Rationale:
Both the CVP and the PAP are extremely high. The high PAP indicates pressure in the lungs
and is partially caused by mechanical ventilation as well as the pneumonia. The high CVP
indicates increased fluid volume. The nurse would evaluate for signs of heart failure as well
as signs of renal failure in this critically ill patient.
21. The nurse observes that a patient being monitored with a pulmonary artery catheter has a
missing c wave. Which of the following does this finding suggest?
1. It is difficult to determine the pulmonary artery occlusion pressure.
2. Nothing, because this wave is often missing from view.
3. It should appear at the end of the QRS complex.
4. It should appear simultaneously with the T-P interval of the ECG.
Answer: It is difficult to determine the pulmonary artery occlusion pressure.
Rationale:
Identification of the c wave on a pulmonary artery catheter tracing is important because prior
to the c wave occurring, the pressure equilibrates between the atrium and the ventricle. If the
c wave is missing, the pulmonary artery occlusion pressure is obtained by averaging the a
wave and x wave. The c wave is often missing with a central venous pressure monitor
tracing. The a wave appears near the end of the QRS complex. The v wave appears
simultaneously with the T-P interval of the ECG.
Test Bank for Timby's Introductory Medical-Surgical Nursing
Loretta A Donnelly-Moreno, Brigitte Moseley
9781975172237, 9781975172268
