NUR 417 Exam 1 Questions With Complete Solutions
***. The nurse is caring for a patient who has an intraaortic
balloon pump in place. Which action would the nurse include in
the plan of care?
a. Avoid the use of anticoagulant medications.
b. Monitor the patient's urinary output every hour.
c. Provide passive range of motion for all extremities.
d. Position the patient supine with head flat at all times. Correct
Answers ANS: B Monitoring urine output will help determine
whether the patient's cardiac output has improved. It also will
help assess for balloon displacement blocking the renal arteries.
The head of the bed can be elevated up to 30 degrees. Heparin is
used to prevent thrombus formation. Limited movement is
allowed for the extremity with the balloon insertion site to
prevent displacement of the balloon.
***An intraaortic balloon pump (IABP) is being used for a
patient who is in cardiogenic shock. Which data would indicate
to the nurse that the goals of IABP treatment are being met?
a. Urine output of 25 mL/hr
b. Heart rate of 110 beats/min
c. Cardiac output (CO) of 5 L/min
d. Stroke volume (SV) of 40 mL/beat Correct Answers ANS: C
A CO of 5 L/min is normal and indicates that the IABP has been
successful in treating the shock. The low SV signifies continued
cardiogenic shock. The tachycardia and low urine output also
suggest continued cardiogenic shock.
,***The nurse is caring for a patient receiving a continuous
norepinephrine IV infusion. Which finding indicates that the
infusion rate may need to be adjusted?
a. Heart rate is slow at 58 beats/min.
b. Mean arterial pressure (MAP) is 56 mm Hg.
c. Systemic vascular resistance (SVR) is elevated.
d. Pulmonary artery wedge pressure (PAWP) is low Correct
Answers ANS: C Vasoconstrictors, such as norepinephrine, will
increase SVR. This will increase the work of the heart and
decrease peripheral perfusion. The infusion rate may need to be
decreased. Bradycardia, hypotension (MAP of 56 mm Hg), and
low PAWP are not associated with norepinephrine infusion.
***Which hemodynamic parameter most directly reflects the
effectiveness of drugs given to reduce a patient's left ventricular
afterload?
a. Cardiac output (CO)
b. Systemic vascular resistance (SVR)
c. Pulmonary vascular resistance (PVR)
d. Pulmonary artery wedge pressure (PAWP) Correct Answers
ANS: B SVR reflects the resistance to left ventricular ejection,
or afterload. Other parameters may be monitored but do not
reflect left-sided afterload as directly.
**A 78-kg patient in septic shock has a pulse rate of 120
beats/min with low central venous pressure and pulmonary
artery wedge pressure. After initial fluid volume resuscitation,
the patient's urine output has been 30 mL/hr for the past 3 hours.
Which intervention prescribed by the health care provider would
the nurse question?
a. Administer furosemide (Lasix) 40 mg IV.
, b. Increase normal saline infusion to 250 mL/hr.
c. Give hydrocortisone (Solu-Cortef) 100 mg IV.
d. Use norepinephrine to keep systolic blood pressure (BP)
above 90 mm Hg. Correct Answers ANS: A Furosemide will
lower the filling pressures and renal perfusion further for the
patient with septic shock. Patients in septic shock require large
amounts of fluid replacement. If the patient remains hypotensive
after initial volume resuscitation with minimally 30 mL/kg,
vasopressors such as norepinephrine may be added. IV
corticosteroids may be considered for patients in septic shock
who cannot maintain an adequate BP with vasopressor therapy
despite fluid resuscitation.
**A nurse is caring for a patient whose hemodynamic
monitoring indicates a blood pressure of 92/54 mm Hg, a pulse
of 64 beats/min, and an elevated pulmonary artery wedge
pressure (PAWP). Which intervention prescribed by the health
care provider would the nurse question?
a. Elevate head of bed to 30 degrees.
b. Infuse normal saline at 250 mL/hr.
c. Hold nitroprusside if systolic BP is less than 90 mm Hg.
d. Titrate dobutamine to keep systolic BP is greater than 90 mm
Hg. Correct Answers ANS: B The patient's elevated PAWP
indicates volume excess in relation to cardiac pumping ability,
consistent with cardiogenic shock. A saline infusion at 250
mL/hr will exacerbate the volume excess. The other actions will
help to improve cardiac output, which should lower the PAWP
and may raise the BP.
**A patient has been admitted with dehydration and
hypotension after 4 days of vomiting and diarrhea. Which
***. The nurse is caring for a patient who has an intraaortic
balloon pump in place. Which action would the nurse include in
the plan of care?
a. Avoid the use of anticoagulant medications.
b. Monitor the patient's urinary output every hour.
c. Provide passive range of motion for all extremities.
d. Position the patient supine with head flat at all times. Correct
Answers ANS: B Monitoring urine output will help determine
whether the patient's cardiac output has improved. It also will
help assess for balloon displacement blocking the renal arteries.
The head of the bed can be elevated up to 30 degrees. Heparin is
used to prevent thrombus formation. Limited movement is
allowed for the extremity with the balloon insertion site to
prevent displacement of the balloon.
***An intraaortic balloon pump (IABP) is being used for a
patient who is in cardiogenic shock. Which data would indicate
to the nurse that the goals of IABP treatment are being met?
a. Urine output of 25 mL/hr
b. Heart rate of 110 beats/min
c. Cardiac output (CO) of 5 L/min
d. Stroke volume (SV) of 40 mL/beat Correct Answers ANS: C
A CO of 5 L/min is normal and indicates that the IABP has been
successful in treating the shock. The low SV signifies continued
cardiogenic shock. The tachycardia and low urine output also
suggest continued cardiogenic shock.
,***The nurse is caring for a patient receiving a continuous
norepinephrine IV infusion. Which finding indicates that the
infusion rate may need to be adjusted?
a. Heart rate is slow at 58 beats/min.
b. Mean arterial pressure (MAP) is 56 mm Hg.
c. Systemic vascular resistance (SVR) is elevated.
d. Pulmonary artery wedge pressure (PAWP) is low Correct
Answers ANS: C Vasoconstrictors, such as norepinephrine, will
increase SVR. This will increase the work of the heart and
decrease peripheral perfusion. The infusion rate may need to be
decreased. Bradycardia, hypotension (MAP of 56 mm Hg), and
low PAWP are not associated with norepinephrine infusion.
***Which hemodynamic parameter most directly reflects the
effectiveness of drugs given to reduce a patient's left ventricular
afterload?
a. Cardiac output (CO)
b. Systemic vascular resistance (SVR)
c. Pulmonary vascular resistance (PVR)
d. Pulmonary artery wedge pressure (PAWP) Correct Answers
ANS: B SVR reflects the resistance to left ventricular ejection,
or afterload. Other parameters may be monitored but do not
reflect left-sided afterload as directly.
**A 78-kg patient in septic shock has a pulse rate of 120
beats/min with low central venous pressure and pulmonary
artery wedge pressure. After initial fluid volume resuscitation,
the patient's urine output has been 30 mL/hr for the past 3 hours.
Which intervention prescribed by the health care provider would
the nurse question?
a. Administer furosemide (Lasix) 40 mg IV.
, b. Increase normal saline infusion to 250 mL/hr.
c. Give hydrocortisone (Solu-Cortef) 100 mg IV.
d. Use norepinephrine to keep systolic blood pressure (BP)
above 90 mm Hg. Correct Answers ANS: A Furosemide will
lower the filling pressures and renal perfusion further for the
patient with septic shock. Patients in septic shock require large
amounts of fluid replacement. If the patient remains hypotensive
after initial volume resuscitation with minimally 30 mL/kg,
vasopressors such as norepinephrine may be added. IV
corticosteroids may be considered for patients in septic shock
who cannot maintain an adequate BP with vasopressor therapy
despite fluid resuscitation.
**A nurse is caring for a patient whose hemodynamic
monitoring indicates a blood pressure of 92/54 mm Hg, a pulse
of 64 beats/min, and an elevated pulmonary artery wedge
pressure (PAWP). Which intervention prescribed by the health
care provider would the nurse question?
a. Elevate head of bed to 30 degrees.
b. Infuse normal saline at 250 mL/hr.
c. Hold nitroprusside if systolic BP is less than 90 mm Hg.
d. Titrate dobutamine to keep systolic BP is greater than 90 mm
Hg. Correct Answers ANS: B The patient's elevated PAWP
indicates volume excess in relation to cardiac pumping ability,
consistent with cardiogenic shock. A saline infusion at 250
mL/hr will exacerbate the volume excess. The other actions will
help to improve cardiac output, which should lower the PAWP
and may raise the BP.
**A patient has been admitted with dehydration and
hypotension after 4 days of vomiting and diarrhea. Which
