Understanding The Essentials Of Critical Care Nursing By Perrin -Test Bank

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Sample Questions Posted Below

 

Chapter 5 Cardiodynamics and Hemodynamics Regulation

1) A patient has a blood pressure of 134/70 per blood pressure cuff and a blood pressure of 90/50 per arterial line.

The nurse should:

1. Discontinue the arterial line immediately.

2. Check the level of the transducer and relevel and rezero the system.

3. Do nothing because this is a normal variation between the two methods of measurement.

4. Begin the infusion of a dopamine drip.

Answer: 2

Explanation: 1. The placement of the transducer is essential for accurate measurement. It must be level with

the phlebostatic axis in order for the monitoring system to be accurate. #1 is not done at this

time because the system needs to be assessed first. #3 is not correct because there is only a 5 to

15 mm Hg difference between the direct and indirect measurements. #4 is not correct because

more information and data are needed before a vasoactive drug is used.

Nursing Process: Implementation

Cognitive Level: Analysis

Category of Need: Physiologic Integrity–Physiologic Adaptation

2. The placement of the transducer is essential for accurate measurement. It must be level with

the phlebostatic axis in order for the monitoring system to be accurate. #1 is not done at this

time because the system needs to be assessed first. #3 is not correct because there is only a 5 to

15 mm Hg difference between the direct and indirect measurements. #4 is not correct because

more information and data are needed before a vasoactive drug is used.

Nursing Process: Implementation

Cognitive Level: Analysis

Category of Need: Physiologic Integrity–Physiologic Adaptation

3. The placement of the transducer is essential for accurate measurement. It must be level with

the phlebostatic axis in order for the monitoring system to be accurate. #1 is not done at this

time because the system needs to be assessed first. #3 is not correct because there is only a 5 to

15 mm Hg difference between the direct and indirect measurements. #4 is not correct because

more information and data are needed before a vasoactive drug is used.

Nursing Process: Implementation

Cognitive Level: Analysis

Category of Need: Physiologic Integrity–Physiologic Adaptation

4. The placement of the transducer is essential for accurate measurement. It must be level with

the phlebostatic axis in order for the monitoring system to be accurate. #1 is not done at this

time because the system needs to be assessed first. #3 is not correct because there is only a 5 to

15 mm Hg difference between the direct and indirect measurements. #4 is not correct because

more information and data are needed before a vasoactive drug is used.

Nursing Process: Implementation

Cognitive Level: Analysis

Category of Need: Physiologic Integrity–Physiologic Adaptation

Learning Outcome: 5–3: Evaluate the accuracy of a pressure monitoring system

Understanding the Ess. of Critical Care Nursing (Perrin) —CVC 12/3/08 — Page 1162) The nurse is monitoring a patientʹs pulmonary vascular resistance. Which value is the normal value?

1. 100–250 mm Hg

2. 10 –250 dynes/sec/cm2

3. 400–800 mm Hg

4. 800–1400 dynes/sec/cm2

Answer: 2

Explanation: 1. The pulmonary system is a low–pressure system. The pressure of the vascular system is

measured in dynes/sec/cm2 due to factors of flow, resistance, and time. #1 and #3 are not

correct because mm Hg is used to measure pressure only. #4 is not correct because this is the

value for SVR.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

2. The pulmonary system is a low–pressure system. The pressure of the vascular system is

measured in dynes/sec/cm2 due to factors of flow, resistance, and time. #1 and #3 are not

correct because mm Hg is used to measure pressure only. #4 is not correct because this is the

value for SVR.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

3. The pulmonary system is a low–pressure system. The pressure of the vascular system is

measured in dynes/sec/cm2 due to factors of flow, resistance, and time. #1 and #3 are not

correct because mm Hg is used to measure pressure only. #4 is not correct because this is the

value for SVR.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

4. The pulmonary system is a low–pressure system. The pressure of the vascular system is

measured in dynes/sec/cm2 due to factors of flow, resistance, and time. #1 and #3 are not

correct because mm Hg is used to measure pressure only. #4 is not correct because this is the

value for SVR.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

Learning Outcome: 5–1: Explain how preload, afterload, and contractility determine cardiac output

Understanding the Ess. of Critical Care Nursing (Perrin) —CVC 12/3/08 — Page 1173) A patientʹs systemic vascular resistance (SVR) has dangerously decreased. The nurse would expect to

administer which medications?

1. Dopamine and furosemide (Lasix)

2. Nitroprusside and furosemide (Lasix)

3. Dopamine and norepinephrine (Levophed)

4. Nitroglycerin and digoxin (Lanoxin)

Answer: 3

Explanation: 1. If the SVR is low, there is massive peripheral vasodilation. These meds will increase vasomotor

tone as well as increase blood pressure. #1 and #2 are incorrect because Lasix is a diuretic that

reduces fluid volume and is a mild vasodilator. #4 is incorrect because nitroglycerin is also a

potent vasodilator.

Nursing Process: Evaluation, Implementation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

2. If the SVR is low, there is massive peripheral vasodilation. These meds will increase vasomotor

tone as well as increase blood pressure. #1 and #2 are incorrect because Lasix is a diuretic that

reduces fluid volume and is a mild vasodilator. #4 is incorrect because nitroglycerin is also a

potent vasodilator.

Nursing Process: Evaluation, Implementation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

3. If the SVR is low, there is massive peripheral vasodilation. These meds will increase vasomotor

tone as well as increase blood pressure. #1 and #2 are incorrect because Lasix is a diuretic that

reduces fluid volume and is a mild vasodilator. #4 is incorrect because nitroglycerin is also a

potent vasodilator.

Nursing Process: Evaluation, Implementation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

4. If the SVR is low, there is massive peripheral vasodilation. These meds will increase vasomotor

tone as well as increase blood pressure. #1 and #2 are incorrect because Lasix is a diuretic that

reduces fluid volume and is a mild vasodilator. #4 is incorrect because nitroglycerin is also a

potent vasodilator.

Nursing Process: Evaluation, Implementation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

Learning Outcome: 5–1 and 5–4: Explain how preload, afterload, and contractility determine cardiac output and Explain

nursing responsibilities in the care of the patient with invasive pressure monitoring systems, including

arterial, central venous, and pulmonary artery pressure lines

Understanding the Ess. of Critical Care Nursing (Perrin) —CVC 12/3/08 — Page 1184) A patient has mixed venous oxygen saturation (SVO2) of 52% with the following hemodynamic findings: CO

of 4.8 L/min, SaO2 of 95%, and an unchanged hemoglobin level. The nurse should assess the patient for:

1. Excessive sedation.

2. Position of the PA catheter.

3. Hypothermia.

4. Pain.

Answer: 4

Explanation: 1. Pain causes an increased consumption of oxygen; therefore the SVO2 level will decrease. #1, #2,

and #3 contribute to a higher than normal SVO2 level due to a lower level of oxygen extracted

by the tissues.

Nursing Process: Evaluation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

2. Pain causes an increased consumption of oxygen; therefore the SVO2 level will decrease. #1, #2,

and #3 contribute to a higher than normal SVO2 level due to a lower level of oxygen extracted

by the tissues.

Nursing Process: Evaluation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

3. Pain causes an increased consumption of oxygen; therefore the SVO2 level will decrease. #1, #2,

and #3 contribute to a higher than normal SVO2 level due to a lower level of oxygen extracted

by the tissues.

Nursing Process: Evaluation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

4. Pain causes an increased consumption of oxygen; therefore the SVO2 level will decrease. #1, #2,

and #3 contribute to a higher than normal SVO2 level due to a lower level of oxygen extracted

by the tissues.

Nursing Process: Evaluation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

Learning Outcome: 5–2: Describe how oxygen supply and demand can be evaluated

Understanding the Ess. of Critical Care Nursing (Perrin) —CVC 12/3/08 — Page 1195) Which of the following actions has the highest priority for maintaining safety when caring for a patient with a

PA catheter?

1. Obtain pressures per protocol.

2. Obtain lab values as ordered.

3. Maintain asepsis when providing line care.

4. Administer fluids and medications via pump.

Answer: 3

Explanation: 1. The presence of all invasive lines can lead to infection and sepsis. Preventing infection is the

highest priority in maintaining patient safety. All other choices are actions that are also correct

but preventing infection and sepsis is the highest.

Nursing Process: Implementation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

2. The presence of all invasive lines can lead to infection and sepsis. Preventing infection is the

highest priority in maintaining patient safety. All other choices are actions that are also correct

but preventing infection and sepsis is the highest.

Nursing Process: Implementation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

3. The presence of all invasive lines can lead to infection and sepsis. Preventing infection is the

highest priority in maintaining patient safety. All other choices are actions that are also correct

but preventing infection and sepsis is the highest.

Nursing Process: Implementation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

4. The presence of all invasive lines can lead to infection and sepsis. Preventing infection is the

highest priority in maintaining patient safety. All other choices are actions that are also correct

but preventing infection and sepsis is the highest.

Nursing Process: Implementation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

Learning Outcome: 5–4: Explain nursing responsibilities in the care of the patient with invasive pressure monitoring

systems, including arterial, central venous, and pulmonary artery pressure lines

Understanding the Ess. of Critical Care Nursing (Perrin) —CVC 12/3/08 — Page 1206) A patient with a right subclavian triple lumen catheter has a CVP reading of 18 mm Hg. The nurse would

further assess the patient for symptoms of:

1. Hypovolemia, hypertension.

2. Orbital edema, disorientation.

3. Decreased peripheral pulses and cool extremities.

4. Peripheral edema, JVD.

Answer: 4

Explanation: 1. An elevated CVP indicates hypervolemia and/or right ventricular failure because it is a direct

measurement of pressure in the right side of the heart. This is manifested by JVD and

peripheral edema

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

2. An elevated CVP indicates hypervolemia and/or right ventricular failure because it is a direct

measurement of pressure in the right side of the heart. This is manifested by JVD and

peripheral edema

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

3. An elevated CVP indicates hypervolemia and/or right ventricular failure because it is a direct

measurement of pressure in the right side of the heart. This is manifested by JVD and

peripheral edema

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

4. An elevated CVP indicates hypervolemia and/or right ventricular failure because it is a direct

measurement of pressure in the right side of the heart. This is manifested by JVD and

peripheral edema

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

Learning Outcome: 5–4: Explain nursing responsibilities in the care of the patient with invasive pressure monitoring

systems, including arterial, central venous, and pulmonary artery pressure lines

Understanding the Ess. of Critical Care Nursing (Perrin) —CVC 12/3/08 — Page 1217) The nurse is monitoring the PA pressure of a mechanically ventilated patient. In order to accurately measure

this pressure, the nurse should obtain the measurement:

1. At the last clear waveform before the baseline rises.

2. At the last clear waveform before the baseline drops.

3. With the patient off the ventilator.

4. Whenever because the timing does not matter.

Answer: 1

Explanation: 1. The positive pressure of the ventilator cause an abnormally high reading during inspiration.

The accurate measurement is the reading seen before the baseline rises. #2 is incorrect because

if it is measured before the baseline drops, this reading is high and is the result of increased

thoracic pressure in the chest from the positive pressure given by the ventilator. Taking the

patient off the ventilator is not an option. Timing is crucial for accuracy.

Nursing Process: Implementation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

2. The positive pressure of the ventilator cause an abnormally high reading during inspiration.

The accurate measurement is the reading seen before the baseline rises. #2 is incorrect because

if it is measured before the baseline drops, this reading is high and is the result of increased

thoracic pressure in the chest from the positive pressure given by the ventilator. Taking the

patient off the ventilator is not an option. Timing is crucial for accuracy.

Nursing Process: Implementation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

3. The positive pressure of the ventilator cause an abnormally high reading during inspiration.

The accurate measurement is the reading seen before the baseline rises. #2 is incorrect because

if it is measured before the baseline drops, this reading is high and is the result of increased

thoracic pressure in the chest from the positive pressure given by the ventilator. Taking the

patient off the ventilator is not an option. Timing is crucial for accuracy.

Nursing Process: Implementation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

4. The positive pressure of the ventilator cause an abnormally high reading during inspiration.

The accurate measurement is the reading seen before the baseline rises. #2 is incorrect because

if it is measured before the baseline drops, this reading is high and is the result of increased

thoracic pressure in the chest from the positive pressure given by the ventilator. Taking the

patient off the ventilator is not an option. Timing is crucial for accuracy.

Nursing Process: Implementation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

Learning Outcome: 5–4: Explain nursing responsibilities in the care of the patient with invasive pressure monitoring

systems, including arterial, central venous, and pulmonary artery pressure lines

Understanding the Ess. of Critical Care Nursing (Perrin) —CVC 12/3/08 — Page 1228) A patient with a PA catheter has an SVO2 of 90%. The nurse should assess the patient for:

1. Fever.

2. Hypothermia.

3. Anemia.

4. Pain.

Answer: 2

Explanation: 1. Normal SVO2 is 60% to 75%. This is a high SVO2 that means that there is not enough

extraction of O2 from the hemoglobin to the tissues. Fever, anemia, and pain all cause a drop

in the SVO2 that may result in cellular hypoxia if it is not remedied.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

2. Normal SVO2 is 60% to 75%. This is a high SVO2 that means that there is not enough

extraction of O2 from the hemoglobin to the tissues. Fever, anemia, and pain all cause a drop

in the SVO2 that may result in cellular hypoxia if it is not remedied.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

3. Normal SVO2 is 60% to 75%. This is a high SVO2 that means that there is not enough

extraction of O2 from the hemoglobin to the tissues. Fever, anemia, and pain all cause a drop

in the SVO2 that may result in cellular hypoxia if it is not remedied.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

4. Normal SVO2 is 60% to 75%. This is a high SVO2 that means that there is not enough

extraction of O2 from the hemoglobin to the tissues. Fever, anemia, and pain all cause a drop

in the SVO2 that may result in cellular hypoxia if it is not remedied.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

Learning Outcome: 5–4: Explain nursing responsibilities in the care of the patient with invasive pressure monitoring

systems, including arterial, central venous, and pulmonary artery pressure lines

Understanding the Ess. of Critical Care Nursing (Perrin) —CVC 12/3/08 — Page 1239) Which of the following would the nurse monitor in response to a change in SVO 2 readings?

1. Hemoglobin level

2. Sodium level

3. Potassium level

4. Glucose level

Answer: 1

Explanation: 1. Oxygen is carried by hemoglobin; this value can influence and is reflected by the SVO2 level.

Nursing Process: Assessment, Evaluation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

2. Oxygen is carried by hemoglobin; this value can influence and is reflected by the SVO2 level.

Nursing Process: Assessment, Evaluation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

3. Oxygen is carried by hemoglobin; this value can influence and is reflected by the SVO2 level.

Nursing Process: Assessment, Evaluation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

4. Oxygen is carried by hemoglobin; this value can influence and is reflected by the SVO2 level.

Nursing Process: Assessment, Evaluation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

Learning Outcome: 5–2: Describe how oxygen supply and demand can be evaluated

10) A patient asks the nurse, ʺWhat is blood pressure?ʺ The nurse would most appropriately respond:

1.ʺThe amount of pressure exerted on your veins by the blood.ʺ

2.ʺA complex measurement that should only be discussed with your health care provider.ʺ

3.ʺA measurement that takes into consideration the amount of blood that your heart is pumping and the

size of the vessel diameter the heart must pump against.ʺ

4.ʺA measurement that should always be 120/80 unless complications are present.ʺ

Answer: 3

Explanation: 1. This is understandable by the patient as well as accurate.

Nursing Process: Assessment, Evaluation

Cognitive Level: Knowledge Comprehension

Category of Need: Physiological Integrity–Physiological Adaptation

2. This is understandable by the patient as well as accurate.

Nursing Process: Assessment, Evaluation

Cognitive Level: Knowledge Comprehension

Category of Need: Physiological Integrity–Physiological Adaptation

3. This is understandable by the patient as well as accurate.

Nursing Process: Assessment, Evaluation

Cognitive Level: Knowledge Comprehension

Category of Need: Physiological Integrity–Physiological Adaptation

4. This is understandable by the patient as well as accurate.

Nursing Process: Assessment, Evaluation

Cognitive Level: Knowledge Comprehension

Category of Need: Physiological Integrity–Physiological Adaptation

Learning Outcome: 5–2: Describe how oxygen supply and demand can be evaluated

Understanding the Ess. of Critical Care Nursing (Perrin) —CVC 12/3/08 — Page 12411) The physician is preparing to insert a PA catheter. The nurse should ensure that:

1. The patient is in the Trendelenburg position to prevent air embolism.

2. The site has been cleaned with soap and water.

3. The patient has received a dose of IV lidocaine.

4. A tourniquet has been applied to the neck.

Answer: 1

Explanation: 1. The Trendelenburg position promotes venous filling in the upper body for easier catheter

insertion and prevention of air embolism. The site should be prepped with antiseptic solution

according to agency protocol. No tourniquet is necessary.

Nursing Process: Implementation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

2. The Trendelenburg position promotes venous filling in the upper body for easier catheter

insertion and prevention of air embolism. The site should be prepped with antiseptic solution

according to agency protocol. No tourniquet is necessary.

Nursing Process: Implementation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

3. The Trendelenburg position promotes venous filling in the upper body for easier catheter

insertion and prevention of air embolism. The site should be prepped with antiseptic solution

according to agency protocol. No tourniquet is necessary.

Nursing Process: Implementation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

4. The Trendelenburg position promotes venous filling in the upper body for easier catheter

insertion and prevention of air embolism. The site should be prepped with antiseptic solution

according to agency protocol. No tourniquet is necessary.

Nursing Process: Implementation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

Learning Outcome: 5–2: Describe how oxygen supply and demand can be evaluated

Understanding the Ess. of Critical Care Nursing (Perrin) —CVC 12/3/08 — Page 12512) In order to correctly calculate cardiac output, the nurse should:

1. Take three to five measurements and take the average of the three readings of the ones within 10% of one

another.

2. Only take two measurements and then average the two readings.

3. Obtain five measurements and record the highest reading.

4. Take one measurement to prevent fluid volume overload.

Answer: 1

Explanation: 1. There could be inconsistency on both temperature and technique. The average of the three

closest measurements is standard to reflect accuracy.

Nursing Process: Implementation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

2. There could be inconsistency on both temperature and technique. The average of the three

closest measurements is standard to reflect accuracy.

Nursing Process: Implementation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

3. There could be inconsistency on both temperature and technique. The average of the three

closest measurements is standard to reflect accuracy.

Nursing Process: Implementation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

4. There could be inconsistency on both temperature and technique. The average of the three

closest measurements is standard to reflect accuracy.

Nursing Process: Implementation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

Learning Outcome: 5–4: Explain nursing responsibilities in the care of the patient with invasive pressure monitoring

systems, including arterial, central venous, and pulmonary artery pressure lines

Understanding the Ess. of Critical Care Nursing (Perrin) —CVC 12/3/08 — Page 12613) Pulsus paradoxus may be seen on arterial pressure waveform monitoring when:

1. There is a decrease of more than 10 mm Hg in the arterial waveform before inhalation.

2. There is a single, nonperfused beat.

3. The waveform has tall, tented waves.

4. The pulse pressure is above 20 mm Hg on exhalation.

Answer: 1

Explanation: 1. There is a change in intrathoracic pressure that affects the filling of the ventricles and this is

reflected in the arterial pressure.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

2. There is a change in intrathoracic pressure that affects the filling of the ventricles and this is

reflected in the arterial pressure.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

3. There is a change in intrathoracic pressure that affects the filling of the ventricles and this is

reflected in the arterial pressure.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

4. There is a change in intrathoracic pressure that affects the filling of the ventricles and this is

reflected in the arterial pressure.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

Learning Outcome: 5–2: Describe how oxygen supply and demand can be evaluated

Understanding the Ess. of Critical Care Nursing (Perrin) —CVC 12/3/08 — Page 12714) The mean arterial pressure is calculated by:

1. Averaging three of the patientʹs blood pressures over a 6–hour period.

2. Dividing the systolic pressure by the diastolic pressure.

3. Adding the systolic pressure and two diastolic pressures then dividing by 3.

4. Dividing the diastolic pressure by the pulse pressure.

Answer: 3

Explanation: 1. This is the gold standard for measuring MAP and it reflects the time the heart is in diastole

during the cardiac cycle.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

2. This is the gold standard for measuring MAP and it reflects the time the heart is in diastole

during the cardiac cycle.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

3. This is the gold standard for measuring MAP and it reflects the time the heart is in diastole

during the cardiac cycle.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

4. This is the gold standard for measuring MAP and it reflects the time the heart is in diastole

during the cardiac cycle.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

Learning Outcome: 5–2: Describe how oxygen supply and demand can be evaluated

15) Contractility of the left side of the heart is measured by:

1. Pulmonary artery wedge pressure.

2. Left atrial pressure.

3. Systemic vascular resistance.

4. Left ventricular stroke work index.

Answer: 4

Explanation: 1. This reflects the stretch and force of contraction of the heart muscle.

Nursing Process: Assessment

Cognitive Level: Comprehension

Category of Need: Physiological Integrity–Physiological Adaptation

2. This reflects the stretch and force of contraction of the heart muscle.

Nursing Process: Assessment

Cognitive Level: Comprehension

Category of Need: Physiological Integrity–Physiological Adaptation

3. This reflects the stretch and force of contraction of the heart muscle.

Nursing Process: Assessment

Cognitive Level: Comprehension

Category of Need: Physiological Integrity–Physiological Adaptation

4. This reflects the stretch and force of contraction of the heart muscle.

Nursing Process: Assessment

Cognitive Level: Comprehension

Category of Need: Physiological Integrity–Physiological Adaptation

Learning Outcome: 5–1: Explain how preload, afterload, and contractility determine cardiac output

Understanding the Ess. of Critical Care Nursing (Perrin) —CVC 12/3/08 — Page 12816) Which of the following interventions should be followed to ensure accurate cardiac output readings?

1. Use 5 cc of iced saline as the injectate.

2. Inject the fluid into the pulmonary artery distal port.

3. Ensure that there is a difference of 10°C between the injectate temperature and the patientʹs body

temperature.

4. Administer the injectate within 4 seconds.

Answer: 4

Explanation: 1. This time frame is necessary to ensure accuracy because the injectate will be pumped out

during one cardiac cycle.

Nursing Process: Implementation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

2. This time frame is necessary to ensure accuracy because the injectate will be pumped out

during one cardiac cycle.

Nursing Process: Implementation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

3. This time frame is necessary to ensure accuracy because the injectate will be pumped out

during one cardiac cycle.

Nursing Process: Implementation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

4. This time frame is necessary to ensure accuracy because the injectate will be pumped out

during one cardiac cycle.

Nursing Process: Implementation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

Learning Outcome: 5–4: Explain nursing responsibilities in the care of the patient with invasive pressure monitoring

systems, including arterial, central venous, and pulmonary artery pressure lines

17) The normal cardiac output is:

1. 2–4 L/min.

2. 4–8 L/min.

3. 6–9 L/min.

4. 8–10 L/min.

Answer: 2

Explanation: 1. The heart pumps the entire blood volume through the body in 1 minute.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

2. The heart pumps the entire blood volume through the body in 1 minute.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

3. The heart pumps the entire blood volume through the body in 1 minute.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

4. The heart pumps the entire blood volume through the body in 1 minute.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

Learning Outcome: 5–1: Explain how preload, afterload, and contractility determine cardiac output

Understanding the Ess. of Critical Care Nursing (Perrin) —CVC 12/3/08 — Page 12918) Causes of reduced preload include which of the following? (Select all that apply.)

1. Vasodilator medications

2. Reduced circulating blood volume

3. Sepsis

4. Mitral stenosis

Answer: 1, 2, 3

Explanation: 1. (Note: This requires multiple responses to be correct.)

Vasodilators enlarge the vessels and reduce resistance. Reduced volume contributes to

decreased filling. Sepsis causes vasodilation due to the release of endotoxins. Mitral stenosis

causes increased preload.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

2. (Note: This requires multiple responses to be correct.)

Vasodilators enlarge the vessels and reduce resistance. Reduced volume contributes to

decreased filling. Sepsis causes vasodilation due to the release of endotoxins. Mitral stenosis

causes increased preload.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

3. (Note: This requires multiple responses to be correct.)

Vasodilators enlarge the vessels and reduce resistance. Reduced volume contributes to

decreased filling. Sepsis causes vasodilation due to the release of endotoxins. Mitral stenosis

causes increased preload.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

4. (Note: This requires multiple responses to be correct.)

Vasodilators enlarge the vessels and reduce resistance. Reduced volume contributes to

decreased filling. Sepsis causes vasodilation due to the release of endotoxins. Mitral stenosis

causes increased preload.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

Learning Outcome: 5–1: Explain how preload, afterload, and contractility determine cardiac output

Understanding the Ess. of Critical Care Nursing (Perrin) —CVC 12/3/08 — Page 13019) A lactate level of 8 mmol/L is a reliable indicator of:

1. Glucose metabolism.

2. Tissue hypoxia.

3. Carbon dioxide exchange.

4. Underuse of oxygen.

Answer: 2

Explanation: 1. When cells become oxygen deprived, anaerobic metabolism of glucose occurs, causing lactate

formation instead of carbon dioxide and water.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

2. When cells become oxygen deprived, anaerobic metabolism of glucose occurs, causing lactate

formation instead of carbon dioxide and water.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

3. When cells become oxygen deprived, anaerobic metabolism of glucose occurs, causing lactate

formation instead of carbon dioxide and water.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

4. When cells become oxygen deprived, anaerobic metabolism of glucose occurs, causing lactate

formation instead of carbon dioxide and water.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

Learning Outcome: 5–1: Explain how preload, afterload, and contractility determine cardiac output

20) The nurse notices that a patient with an arterial line has an elevated PTT and is not on anticoagulation therapy.

The nurse should:

1. Change the heparinized saline solution in the pressure bag for the arterial line to a normal saline solution.

2. Ask for an order to begin Lovenox therapy.

3. Assess for the presence of a DVT.

4. Take the patient for a STAT V/Q scan.

Answer: 1

Explanation: 1. The patient may have a coagulopathy or HITS.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

2. The patient may have a coagulopathy or HITS.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

3. The patient may have a coagulopathy or HITS.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

4. The patient may have a coagulopathy or HITS.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

Learning Outcome: 5–3: Evaluate the accuracy of a pressure monitoring system

Understanding the Ess. of Critical Care Nursing (Perrin) —CVC 12/3/08 — Page 13121) Prior to the insertion of an arterial line in the radial artery, which assessment needs to be performed?

1. Homanʹs test

2. Allenʹs test

3. Kernigʹs test

4. Leopoldʹs maneuver

Answer: 2

Explanation: 1. The Allenʹs test detects the patency of the ulnar artery. This is to ensure that there is adequate

blood flow to the hand in the event the radial artery becomes occluded.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

2. The Allenʹs test detects the patency of the ulnar artery. This is to ensure that there is adequate

blood flow to the hand in the event the radial artery becomes occluded.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

3. The Allenʹs test detects the patency of the ulnar artery. This is to ensure that there is adequate

blood flow to the hand in the event the radial artery becomes occluded.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

4. The Allenʹs test detects the patency of the ulnar artery. This is to ensure that there is adequate

blood flow to the hand in the event the radial artery becomes occluded.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

Learning Outcome: 5–3: Evaluate the accuracy of a pressure monitoring system

Understanding the Ess. of Critical Care Nursing (Perrin) —CVC 12/3/08 — Page 13222) When observing the waveform of an arterial line, the nurse notes the presence of a dicrotic notch. The nurse

knows this due to:

1. Mitral valve closure.

2. Tricuspid valve closure.

3. Aortic valve closure.

4. Pulmonic valve opening.

Answer: 3

Explanation: 1. The aortic valve closes and the mitral and tricuspid valves open in preparation for ventricular

filling. The pulmonic valve closes at the same time as the aortic valve.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

2. The aortic valve closes and the mitral and tricuspid valves open in preparation for ventricular

filling. The pulmonic valve closes at the same time as the aortic valve.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

3. The aortic valve closes and the mitral and tricuspid valves open in preparation for ventricular

filling. The pulmonic valve closes at the same time as the aortic valve.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

4. The aortic valve closes and the mitral and tricuspid valves open in preparation for ventricular

filling. The pulmonic valve closes at the same time as the aortic valve.

Nursing Process: Assessment

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

Learning Outcome: 5–3: Evaluate the accuracy of a pressure monitoring system

Understanding the Ess. of Critical Care Nursing (Perrin) —CVC 12/3/08 — Page 13323) The nurse suspects that a patient is experiencing cardiogenic shock. Which parameter indicates that the nurseʹs

suspicion is correct?

1. Cardiac output of 8.9 L/min

2. Pulmonary artery wedge pressure (PAWP) of 8 mm Hg

3. Cardiac index (CI) of 1.8 L/min/m2

4. Central venous pressure (CVP) of 5 mm Hg

Answer: 3

Explanation: 1. The cardiac index (CI) is a measure of cardiac output and tissue perfusion in relation to the

patientʹs body surface area. It is more accurate than cardiac output. #1 is not correct because it

is elevated. #2 is not correct because the PAWP will be elevated in cardiogenic shock.

Nursing Process: Evaluation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

2. The cardiac index (CI) is a measure of cardiac output and tissue perfusion in relation to the

patientʹs body surface area. It is more accurate than cardiac output. #1 is not correct because it

is elevated. #2 is not correct because the PAWP will be elevated in cardiogenic shock.

Nursing Process: Evaluation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

3. The cardiac index (CI) is a measure of cardiac output and tissue perfusion in relation to the

patientʹs body surface area. It is more accurate than cardiac output. #1 is not correct because it

is elevated. #2 is not correct because the PAWP will be elevated in cardiogenic shock.

Nursing Process: Evaluation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

4. The cardiac index (CI) is a measure of cardiac output and tissue perfusion in relation to the

patientʹs body surface area. It is more accurate than cardiac output. #1 is not correct because it

is elevated. #2 is not correct because the PAWP will be elevated in cardiogenic shock.

Nursing Process: Evaluation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

Learning Outcome: 5–1: Explain how preload, afterload, and contractility determine cardiac output

Understanding the Ess. of Critical Care Nursing (Perrin) —CVC 12/3/08 — Page 13424) A patientʹs hemodynamic parameters include the following: right atrial pressure (RAP) of 13 mm Hg,

pulmonary artery wedge pressure (PAWP) of 8 mm Hg, systemic vascular resistance (SVR) of 1000

dynes/sec/cm2, cardiac output (CO) of 4.9 L/min, cardiac index (CI) of 3.5 L/min, and pulmonary vascular

resistance (PVR) of 280 dynes/sec/cm2

. Which heart function should cause the nurse concern?

1. Afterload

2. Left heart contractility

3. Right heart contractility

4. Heart rate

Answer: 3

Explanation: 1. The RAP reflects the amount of blood returning to the right atrium and is a measurement of

preload. The elevated PVR is a reflection of the pressure within the right ventricle and is the

amount of pressure needed for the right ventricle to eject blood into the PA. The elevated RAP

and PVR indicate a problem with right heart contractility and is most likely related to right

heart failure. #4 is incorrect because heart rate is not referred to. #1 and #2 are incorrect because

the CO, CI, and SVR are within normal limits and are indicators of left ventricular function.

Nursing Process: Evaluation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

2. The RAP reflects the amount of blood returning to the right atrium and is a measurement of

preload. The elevated PVR is a reflection of the pressure within the right ventricle and is the

amount of pressure needed for the right ventricle to eject blood into the PA. The elevated RAP

and PVR indicate a problem with right heart contractility and is most likely related to right

heart failure. #4 is incorrect because heart rate is not referred to. #1 and #2 are incorrect because

the CO, CI, and SVR are within normal limits and are indicators of left ventricular function.

Nursing Process: Evaluation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

3. The RAP reflects the amount of blood returning to the right atrium and is a measurement of

preload. The elevated PVR is a reflection of the pressure within the right ventricle and is the

amount of pressure needed for the right ventricle to eject blood into the PA. The elevated RAP

and PVR indicate a problem with right heart contractility and is most likely related to right

heart failure. #4 is incorrect because heart rate is not referred to. #1 and #2 are incorrect because

the CO, CI, and SVR are within normal limits and are indicators of left ventricular function.

Nursing Process: Evaluation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

4. The RAP reflects the amount of blood returning to the right atrium and is a measurement of

preload. The elevated PVR is a reflection of the pressure within the right ventricle and is the

amount of pressure needed for the right ventricle to eject blood into the PA. The elevated RAP

and PVR indicate a problem with right heart contractility and is most likely related to right

heart failure. #4 is incorrect because heart rate is not referred to. #1 and #2 are incorrect because

the CO, CI, and SVR are within normal limits and are indicators of left ventricular function.

Nursing Process: Evaluation

Cognitive Level: Analysis

Category of Need: Physiological Integrity–Physiological Adaptation

Learning Outcome: 5–1: Explain how preload, afterload, and contractility determine cardiac output

Understanding the Ess. of Critical Care Nursing (Perrin) —CVC 12/3/08 — Page 135