NUR 445 FINAL EXAM 2026 ACTUAL QUESTIONS AND
ANSWERS GRADED A+
✔✔Why is CI more useful than CO? - ✔✔CI takes into account the size and CO of the
person
✔✔What is the normal range for CO/CI? - ✔✔2.4-4.0 L/min?m^2
✔✔What are 2 major determinants of CO? - ✔✔HR and SV
✔✔Why is adequate CO important? - ✔✔to ensure oxygen transport needs, preventing
low CO and shock
✔✔What is stroke volume? - ✔✔The amount of blood ejected by each heart beat
✔✔What 3 factors affect stroke volume? - ✔✔preload, after load, and contractility
✔✔What is preload? - ✔✔How stretched the ventricles get by the volume it holds
✔✔What causes low preload? - ✔✔fluid volume deficits
(loss of volume, vasodilation, etc)
✔✔What causes high preload? - ✔✔fluid volume overload and HF
✔✔What is afterload? - ✔✔the resistance the ventricle must overcome to eject blood
into circulation
✔✔Why is an increased afterload concerning? - ✔✔The ventricle doesn't fully empty =
low SV and CO
(The heart is working harder, which requires more oxygen)
✔✔What is contractility? - ✔✔property of myocardial fibers that allows them to
shorten/squeeze
✔✔What does strong contractility look like? - ✔✔Increased SV and great CO
✔✔What does poor contractility look like? - ✔✔Decreased SV and poor CO
(HF, hypovolemia)
✔✔How can central venous pressure (CVP) be measured? - ✔✔through a central
venous catheter
(transducer/computer or visual)
,✔✔Where is the tip of the central line located? - ✔✔in the superior vena cava near the
entrance to the right atrium
✔✔What is the normal range for CVP? - ✔✔2 to 6 mmHg
✔✔What are some complications of central lines? - ✔✔pneumothorax, hemothorax,
hematoma, arterial puncture, infection
✔✔When might an arterial line be placed? - ✔✔If the pt has hemodynamic instability,
requires frequent monitoring of systemic BP, MAP, or frequently ABGs are drawn
✔✔What is a normal MAP? - ✔✔70-90 mmHg
✔✔What is the purpose of a pulmonary artery (PA) catheter? - ✔✔Determines direct
pressures/volumes within the right heart, indirect measures of left heart, cardiac output,
sample mixed blood (SVO2), and provide various therapies (fluid, meds, cardiac pacing,
etc
✔✔What 3 steps are crucial following a hemodynamic assessment of a patient with a
PA catheter? - ✔✔obtain accurate data, correctly analyze waveforms, and integrate
data with patient assessment
✔✔What guidelines must be followed when interpreting PA data? - ✔✔look at trends,
question abnormal readings, recheck equipment, consider the patient's normal values,
assess every reading
✔✔What is a transducer? - ✔✔piece of equipment that translates medical energy
sensed by catheter into electrical energy, displayed on the monitor as a waveform
✔✔Why is it critical to level and zero the transducer? - ✔✔Leveling corrects for
hydrostatic pressure changes in vessels above and below the heart, and corrects for
any drift/deviation from baseline
✔✔What is the phlebostatic axis? - ✔✔approximates the level of the right atrium and
represents the level of the catheter tip
✔✔What anatomic position is the landmark for leveling a transducer? - ✔✔In supine
position, 4th intercostal space, 1/2 the anterior/posterior diameter of the chest
✔✔What is the pressure bag used for? - ✔✔to overcome the pressure within the
pulmonary artery and prevent blood from backing up into the pressure tubing
✔✔What value should the pressure bag be set at? - ✔✔300 mmHg
, ✔✔What are some important guidelines for preventing CLABSIs? - ✔✔hand hygiene,
keep dressing clean, keep lines patent
✔✔How can we measure preload? - ✔✔via right arterial pressure (RAP) and pulmonary
artery wedge pressure (PAWP)
Right side = RAP, left side = PAWP
✔✔How can we measure afterload? - ✔✔Using PA catheter measurements
Right side = PVR, left side = SVR
✔✔What is the normal range for RAP? - ✔✔2 to 6 mmHg
✔✔What can caused an increased RAP? - ✔✔HF, excessive intake, ant condition that
increases pressure/volume in the lungs
✔✔What symptoms would you anticipate seeing in a patient with increased RAP? -
✔✔depends on the cause and duration of fluid volume excess
✔✔How is increased RAP treated? - ✔✔diuretics, vasodilators, fluid and Na+
restrictions, strict I&Os, daily weights, careful and frequent assessments, promoting
rest, dietary consults, patient education on meds/diet
✔✔What can cause a decreased RAP? - ✔✔hypovolemia, poor venous return,
hemorrhage, excess diuresis, drug-induced vasodilation, third-spacing, vomiting,
diarrhea, dehydration
✔✔What symptoms would you anticipate seeing in a patient with decreased RAP? -
✔✔findings of volume deficit, and eventually shock
✔✔How is decreased RAP treated? - ✔✔antibiotics (if sepsis related), vasoconstrictors,
IV nitrates, oral replacement, IV hydration, blood products, crystalloid IV fluids, surgical
intervention to stop bleeding if necessary, strict I&Os, daily weights, frequent
assessments
✔✔What does the pulmonary artery systolic (PAS) pressure reflect? - ✔✔the highest
pressure generated by the right ventricle during systole
✔✔What is the normal range for PAS? - ✔✔20-30 mmHg
✔✔What does the pulmonary artery diastolic (PAD) pressure reflect? - ✔✔reflects the
lowest pressure within the pulmonary artery
✔✔What is the normal range for PAD? - ✔✔8-15 mmHg
ANSWERS GRADED A+
✔✔Why is CI more useful than CO? - ✔✔CI takes into account the size and CO of the
person
✔✔What is the normal range for CO/CI? - ✔✔2.4-4.0 L/min?m^2
✔✔What are 2 major determinants of CO? - ✔✔HR and SV
✔✔Why is adequate CO important? - ✔✔to ensure oxygen transport needs, preventing
low CO and shock
✔✔What is stroke volume? - ✔✔The amount of blood ejected by each heart beat
✔✔What 3 factors affect stroke volume? - ✔✔preload, after load, and contractility
✔✔What is preload? - ✔✔How stretched the ventricles get by the volume it holds
✔✔What causes low preload? - ✔✔fluid volume deficits
(loss of volume, vasodilation, etc)
✔✔What causes high preload? - ✔✔fluid volume overload and HF
✔✔What is afterload? - ✔✔the resistance the ventricle must overcome to eject blood
into circulation
✔✔Why is an increased afterload concerning? - ✔✔The ventricle doesn't fully empty =
low SV and CO
(The heart is working harder, which requires more oxygen)
✔✔What is contractility? - ✔✔property of myocardial fibers that allows them to
shorten/squeeze
✔✔What does strong contractility look like? - ✔✔Increased SV and great CO
✔✔What does poor contractility look like? - ✔✔Decreased SV and poor CO
(HF, hypovolemia)
✔✔How can central venous pressure (CVP) be measured? - ✔✔through a central
venous catheter
(transducer/computer or visual)
,✔✔Where is the tip of the central line located? - ✔✔in the superior vena cava near the
entrance to the right atrium
✔✔What is the normal range for CVP? - ✔✔2 to 6 mmHg
✔✔What are some complications of central lines? - ✔✔pneumothorax, hemothorax,
hematoma, arterial puncture, infection
✔✔When might an arterial line be placed? - ✔✔If the pt has hemodynamic instability,
requires frequent monitoring of systemic BP, MAP, or frequently ABGs are drawn
✔✔What is a normal MAP? - ✔✔70-90 mmHg
✔✔What is the purpose of a pulmonary artery (PA) catheter? - ✔✔Determines direct
pressures/volumes within the right heart, indirect measures of left heart, cardiac output,
sample mixed blood (SVO2), and provide various therapies (fluid, meds, cardiac pacing,
etc
✔✔What 3 steps are crucial following a hemodynamic assessment of a patient with a
PA catheter? - ✔✔obtain accurate data, correctly analyze waveforms, and integrate
data with patient assessment
✔✔What guidelines must be followed when interpreting PA data? - ✔✔look at trends,
question abnormal readings, recheck equipment, consider the patient's normal values,
assess every reading
✔✔What is a transducer? - ✔✔piece of equipment that translates medical energy
sensed by catheter into electrical energy, displayed on the monitor as a waveform
✔✔Why is it critical to level and zero the transducer? - ✔✔Leveling corrects for
hydrostatic pressure changes in vessels above and below the heart, and corrects for
any drift/deviation from baseline
✔✔What is the phlebostatic axis? - ✔✔approximates the level of the right atrium and
represents the level of the catheter tip
✔✔What anatomic position is the landmark for leveling a transducer? - ✔✔In supine
position, 4th intercostal space, 1/2 the anterior/posterior diameter of the chest
✔✔What is the pressure bag used for? - ✔✔to overcome the pressure within the
pulmonary artery and prevent blood from backing up into the pressure tubing
✔✔What value should the pressure bag be set at? - ✔✔300 mmHg
, ✔✔What are some important guidelines for preventing CLABSIs? - ✔✔hand hygiene,
keep dressing clean, keep lines patent
✔✔How can we measure preload? - ✔✔via right arterial pressure (RAP) and pulmonary
artery wedge pressure (PAWP)
Right side = RAP, left side = PAWP
✔✔How can we measure afterload? - ✔✔Using PA catheter measurements
Right side = PVR, left side = SVR
✔✔What is the normal range for RAP? - ✔✔2 to 6 mmHg
✔✔What can caused an increased RAP? - ✔✔HF, excessive intake, ant condition that
increases pressure/volume in the lungs
✔✔What symptoms would you anticipate seeing in a patient with increased RAP? -
✔✔depends on the cause and duration of fluid volume excess
✔✔How is increased RAP treated? - ✔✔diuretics, vasodilators, fluid and Na+
restrictions, strict I&Os, daily weights, careful and frequent assessments, promoting
rest, dietary consults, patient education on meds/diet
✔✔What can cause a decreased RAP? - ✔✔hypovolemia, poor venous return,
hemorrhage, excess diuresis, drug-induced vasodilation, third-spacing, vomiting,
diarrhea, dehydration
✔✔What symptoms would you anticipate seeing in a patient with decreased RAP? -
✔✔findings of volume deficit, and eventually shock
✔✔How is decreased RAP treated? - ✔✔antibiotics (if sepsis related), vasoconstrictors,
IV nitrates, oral replacement, IV hydration, blood products, crystalloid IV fluids, surgical
intervention to stop bleeding if necessary, strict I&Os, daily weights, frequent
assessments
✔✔What does the pulmonary artery systolic (PAS) pressure reflect? - ✔✔the highest
pressure generated by the right ventricle during systole
✔✔What is the normal range for PAS? - ✔✔20-30 mmHg
✔✔What does the pulmonary artery diastolic (PAD) pressure reflect? - ✔✔reflects the
lowest pressure within the pulmonary artery
✔✔What is the normal range for PAD? - ✔✔8-15 mmHg
