Chapter 31 Medical Surgical Nursing Preparation For Practice 2nd Edition

Chapter 31  Medical Surgical Nursing Preparation For Practice 2nd Edition

Complete Chapter Questions And Answers
 

Sample Questions

Question 1
Type: MCSA
The nurse is in orientation for a new job caring for patients in the intensive care area. Which statement indicates to the preceptor that the new nurse needs more information about hemodynamic monitoring?
1. “Data from hemodynamic monitoring can be used to evaluate the patient’s progress.”
2. “Hemodynamic monitoring data can help to guide fluid administration and prevent fluid overload.”
3. “Hemodynamic monitoring data can be used to aid in the diagnosis of lung disorders.”
4. “One drawback of hemodynamic monitoring is that the catheter must go through the heart and into the pulmonary artery.”
Correct Answer: 4
Rationale 1: One of the purposes of hemodynamic monitoring is evaluating patient response to therapy.
Rationale 2: One of the purposes of hemodynamic monitoring is guiding therapy to minimize or correct dysfunction.
Rationale 3: Hemodynamic monitoring can help to diagnose and treat a number of disorders, including disorders of the lung.
Rationale 4: 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.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 31-1

Question 2
Type: MCSA
A family member of a critically ill patient is verbalizing the purpose of hemodynamic monitoring. Which statement 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 blood comes out of the heart each minute.”
3. “The hemodynamic monitor can measure how much oxygen is left in the blood after it circulates through the body.”
4. “The hemodynamic monitor can measure how much pressure is in the heart.”
Correct Answer: 1
Rationale 1: 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.
Rationale 2: An example of such a measurement is thermodilution cardiac output.
Rationale 3: An example of such a measurement is continuous mixed venous oxygen saturation.
Rationale 4: An example of such a measurement is pulmonary artery occlusion pressure (PAOP), an indirect measurement of left ventricular end-diastolic pressure.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 31-1

Question 3
Type: MCSA
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” because it is not a smooth line. What is the nurse’s best response?
1. “What you are seeing is called a dicrotic notch, and it means the beginning of the resting phase of your heart.”
2. “It is nothing for you to be concerned about. It is just a measurement of your blood pressure.”
3. “You are right. I will see if you are prescribed any medication for that problem.”
4. “You are seeing the strongest part of your heart muscle, which is the first number of a blood pressure reading.”
Correct Answer: 1
Rationale 1: The dicrotic notch represents closure of the aortic valve and distinguishes the beginning of diastole or the resting phase of the heart ventricles.
Rationale 2: The nurse should not minimize the patient’s concern.
Rationale 3: The nurse should not agree with the patient or suggest that the patient might need medication.
Rationale 4: The dicrotic notch does not signify the first number of a blood pressure reading.
Global Rationale:

Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Physiological Adaptation
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 31-1

Question 4
Type: MCSA
The role of the nurse who is caring for a patient with invasive hemodynamic monitoring includes which important interventions?
1. Keeping IV solutions at atmospheric pressure so the monitor obtains accurate patient pressures
2. Frequent reassessment and evaluation of data in order to tailor therapies to the patient
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
Correct Answer: 2
Rationale 1: IV solutions are kept at 300 mmHg.
Rationale 2: An important nursing intervention is the 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.
Rationale 3: Fluids are infused constantly through the system to prevent clotting of the line.
Rationale 4: The hemodynamic transducer is zeroed using the phlebostatic axis as a reference.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 31-2