CCRN Practice(questions and completed answers 2022)

You are monitoring a patient with a pulmonary artery catheter. You are unable to measure the patient's pulmonary artery wedge pressure. To obtain a value that corresponds to the pulmonary artery wedge pressure, you check the: A. Right ventricular pressure B. Pulmonary artery diastolic pressure C. Pulmonary artery mean pressure D. Right atrial pressure B. Pulmonary artery diastolic pressure When you cannot obtain a pulmonary artery wedge pressure, use the pulmonary artery diastolic pressure to detect trends in the pulmonary artery wedge pressure. The pulmonary artery diastolic pressure is usually 1 to 4 mm/Hg higher than pulmonary artery wedge pressure. However, a patient with pulmonary disease has pulmonary artery diastolic pressure influenced by higher right heart pressures, which do not correlate with the pulmonary artery wedge pressure. (Recall that pulmonary artery wedge pressure is a measure of left-sided heart pressure). The right atrial and right ventricular pressures reflect right-sided, not left-sided, heart pressures. Use the pulmonary artery mean pressure to calculate pulmonary vascular resistance. You are monitoring a patient's pulmonary artery catheter. The pulmonary artery waveform spontaneously changes to a pulmonary artery wedge pressure waveform. Choose the correct intervention: A. Immediately pull the catheter back to the right atrium B. Monitor the patient for ventricular ectopy C. Inflate the balloon with 1.5 cc of air D. Check that the balloon is fully deflated D. Check that the balloon is fully deflated 00:02 01:14 Your patient's hemodynamic parameters are: Right atrial pressure of 4 mm/Hg; pulmonary artery wedge pressure of 7 mm/Hg; systemic vascular resistance of 1,000 dynes/sec/cm-5; cardiac index of 3.5 L/minute; and left ventricular stroke work index of 20 beats/minute. The heart function that concerns you most is: A. Contractility B. Preload C. Cardiac output D. Afterload A. Contractility The normal value for a left ventricular stroke work index is 35 to 85 beats/minute. Your patient's abnormally low left ventricular stroke work index of 20 beats/minute reflects a problem with contractility in his or her left ventricle. Afterload is reflected in the systemic vascular resistance, preload in the pulmonary artery wedge pressure, and cardiac output in the cardiac index; these three values are within normal limits. You should be concerned that your patient's poor cardiac muscle contractility will lead to insufficient cardiac output. Observe your patient for fatigue, peripheral edema, and shortness of breath (SOB). Your patient's pulmonary artery catheter readings show: Right atrial pressure of 6 mm/Hg; pulmonary artery wedge pressure of 10 mm/Hg; cardiac output of 6 L/minute; and systemic vascular resistance of 1,700 dynes/sec/cm-5. Choose the I.V. infusion drug that will bring the abnormal value into the desired range: A. Nitroprusside B. Amrinone (INN) C. Lidocaine D. Dobutamine A. Nitroprusside Normal systemic vascular resistance ranges from 900 to 1,600 dynes/sec/cm-5 and is a measure of afterload. Your patient's systemic vascular resistance of 1,700 dynes/sec/cm-5 is too high and must be lowered. Nitroprusside is a vasodilator that reduces afterload and lowers the systemic vascular resistance. Dobutamine and amrinone are positive inotropic drugs that affect cardiac output. Lidocaine does not alter pulmonary artery catheter readings. Therefore, nitroprusside is the correct choice for your attempt to lower your patient's systemic vascular resistance by at least 100 dynes/sec/cm-5. Your patient's blood pressure is 130/70 mm/Hg on auscultation and 90/50 mm/Hg measured directly through an arterial catheter. Choose the correct action: A. Check the transducer level B. Do nothing, because this is a normal variation C. Pull out the arterial line D. Alert the physician immediately A. Check the transducer level Your patient has undergone emergency intubation. Choose the correct intervention to perform first: A. Note the centimeter lip-line marking B. Check for bilateral breath sounds C. Measure peak airway pressure D. Get a STAT chest x-ray B. Check for bilateral breath sounds Your patient was transferred to Coronary Care from the Medical-Surgical floor. Your patient has a pulmonary artery catheter inserted and is in septic shock. The best way to check your patient's right-sided afterload is by measuring: A. Systemic vascular resistance B. Left ventricular stroke work C. Right ventricular stroke work D. Pulmonary vascular resistance D. Pulmonary vascular resistance Pulmonary vascular resistance measures the right ventricle's resistance to ejection. Afterload is the force against which a ventricle contracts. Determine right-sided afterload by measuring resistance to ejection from the right ventricle. To assess right-sided afterload, measure pulmonary vascular resistance. Left and right ventricular stroke work measure the effort of each ventricle per stroke. Systemic vascular resistance measures the resistance to ejection from the left ventricle. Twenty-four hours after coronary artery bypass graft surgery, your patient becomes increasingly agitated and confused. His blood pressure is difficult to auscultate. His heart rate is 130 beats/minute. His respirations are 28 breaths/minute. When auscultating his breath sounds, you find new crackles one-third up in both lung fields. Your patient's pulmonary artery wedge pressure is 22 mm/Hg. Based on these findings, you suspect: A. Hypovolemia B. Myocardial infarction C. Pulmonary edema D. Cardiac tamponade C. Pulmonary edema A patient with mitral regurgitation just had a pulmonary artery catheter inserted. You expect your patient's pressure values to show: A. Low right atrial pressure B. High right atrial pressure C. Low pulmonary artery wedge pressure D. High pulmonary capillary wedge pressure D. High pulmonary capillary wedge pressure Your patient's systemic vascular resistance has decreased. You increase his systemic vascular resistance by giving: A. Nitroprusside (Nitropress) and furosemide (Lasix) B. Dopamine (Intropin) and furosemide (Lasix) C. Dopamine (Intropin) and norepinephrine (Levophed) D. Nitroglycerin (Tridil) and dobutamine (Dobutrex) C. Dopamine (Intropin) and norepinephrine (Levophed) Your patient with acute respiratory distress syndrome is ventilated with positive end-expiratory pressure (PEEP). Identify the top priority nursing intervention: A. Monitor for tachyarrhythmia B. Monitor blood pressure C. Perform chest physiotherapy D. Monitor blood sugar levels B. Monitor blood pressure Monitor your patient's blood pressure because PEEP can decrease cardiac output, causing blood pressure to drop. Tachyarrhythmia and blood sugar level changes do not occur with PEEP. Chest physiotherapy is useful but is not a priority for a patient receiving PEEP. Your patient appears comfortable. However, a pulse oximetry alarm sounds and his oxygen saturation reads 80%. Identify your first action: A. Palpate the patient's pulse B. Palpate for a pulse and auscultate breath sounds C. Check the temperature of the patient's feet to determine if his toes are cold D. Compare the heart rate reported by the pulse oximetry unit to his actual heart rate to find out if they match D. Compare the heart rate reported by the pulse oximetry unit to his actual heart rate to find out if they match Always check a match between the heart rate reported on the pulse oximetry unit and the patient's actual heart rate to confirm the equipment is functioning properly. Before checking breath sounds or pulse, ask the patient how he feels. Cold toes affect pulse oximetry only if the probe is attached to the patient's toes. You find the endotracheal tube cuff pressure of an intubated patient is 20 cm H2O. Identify the correct response: A. Do nothing, as 20 cm H2O is within normal limits B. Call a Respiratory Therapist to evaluate the tube's function C. Inflate the cuff by 5 cm H2O pressure D. Deflate the cuff by 5 cm H2O pressure A. Do nothing, as 20 cm H2O is within normal limits The most appropriate action is to do nothing; 20 cm H2O is a normal cuff pressure for an endotracheal tube. Your patient does not require respiratory therapy at this time because the endotracheal tube is functioning properly. Your patient sustained a pneumothorax in a motor vehicle accident several days ago. The physician installed a chest tube to treat the pneumothorax and now wants to remove it. Identify the first step you must perform before removal: A. Have the patient sign a consent form for the removal B. Clamp the tube for 2 hours before its removal C. Have a unit of packed red blood cells available for immediate transfusion D. Premedicate your patient one hour before the procedure to ensure her comfort during the procedure D. Premedicate your patient one hour before the procedure to ensure her comfort during the procedure You assess the function of an intra-aortic balloon pump (IABP) inserted after a cardiac transplant. You know the IABP functions properly if the balloon inflates: A. Near the dichrotic notch B. At the end of a diastole C. At the end of a systole D. Near the T-wave on the electrocardiogram (EKG) A. Near the dichrotic notch The IABP balloon should inflate with a diastole, which is identified at the dichrotic notch on an arterial line pressure waveform. Balloon inflation at the end of a systole is too early in the cycle. Inflation at the end of diastole would cause inflation during systole, which is dangerous and possibly fatal. EKG waveform does not indicate the function or inflation of an intra-aortic balloon pump.