1. The 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
ra... [Show More] te 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/cm–5
d. Systemic vascular resistance (SVR) of 1400 dynes/sec/cm–5
A cardiac index of 1.2 L/min/m3
combined with the identified clinical assessment findings indicate a low cardiac output with fluid overload (bilateral
crackles), requiring intervention. The remaining hemodynamic values are within normal limits: cardiac output of 4 L/min; pulmonary vascular resistance
of 80 dynes/sec/cm–5; and the systemic vascular resistance of 1400 dynes/sec/cm–5
.
2. 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
Low pulmonary artery occlusion pressures usually indicate volume depletion, so intravenous fluids would be indicated. A normal hourly urine
output is 1 mL/kg or at least 30 mL/hour, so this is another indication that the patient is volume depleted. Administration of diuretics would worsen the
patient’s volume status. Negative inotropes would not improve the patient’s volume status. Vasopressors will increase blood pressure but are
contraindicated in a low volume state.
3. The nurse 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 that all tubing connections are tightened.
c. Obtain a portable x-ray to confirm placement.
d. Restrain the affected extremity for 24 hours.
Loose connections in hemodynamic monitoring tubing can lead to hemorrhage, a major complication of arterial pressure monitoring. Application of a
pressure dressing is required only upon arterial line removal. Blood return is adequate confirmation of arterial line placement; radiography is not
performed to confirm arterial line placement. Neutral positioning of the extremity and use of an arm board, without limb restraint, is the standard of care.
4. 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 provider immediately of the assessment findings.
c. Obtain a stat chest x-ray film to verify proper catheter placement.
d. Zero reference and level th [Show Less]
