BSN 445 WEEK 4 CARDIOVASCULAR CLINICAL ASSESSMENT .

BSN 445 WEEK 4 CARDIOVASCULAR
CLINICAL ASSESSMENT.
HemodynamicyMonitoring:
Questiony1yofy4
TheynurseyisypreparingytoyperformytheyAllenytestyforyaypatientywhoyrequiresyanyintra
arterialybloodypressureymonitoringycatheter.yInywhichyorderywouldytheynurseyperfor
mytheystepsyofytheyAllenytest?
1.yCompressytheyradialyandyulnaryarteriesysimultaneously.y
2.yAskytheypatientytoyclenchyandyunclenchytheyhand.y
3.Observeyforyblanching.y
4.Removeypressureyfromytheyulnaryartery.y
5.yObserveyforyimmediateyflushingyofytheyhand.y-yCORRECTyANSWER-
TheyAllenytestyassessesytheypresenceyofycollateralycirculationypriorytoyradialyarteryyc
annulation;ytheytestyassessesytheysupplyyofycollateralycirculationytoytheyhandyprovide
dybyytheyulnaryarteryythroughytheypalmaryarch.yWhenyperformingytheytest,ytheynurse
ywouldyfirstycompressytheyradialyandyulnaryarteriesysimultaneouslyyandythenyaskythe

ypatientytoyclenchyandyunclenchytheyhandyuntilyityblanches.yTheynurseywouldythenyrel

easeyoneyofytheyarteriesyandyobserveyforyimmediateyflushingyonythatysideyofytheyhand
.

Questiony2yofy4
Matchytheyhemodynamicypressureytoytheycorrespondingyexplanation.
CorrectyAnswery
Exactly!
Averageyperfusionypressureycreatedyduringytheycardiacycycle
=Meanyarterialypressure
Pressureycreatedybyyvolumeyinytheyrightysideyofytheyheart
=Centralyvenousypressure
Fillingypressuresyinytheyleftyofytheyheartywhenytheymitralyvalveyisyclosed
=Leftyatrialypressure
Amountyofybloodypumpedyoutybyyayventricleyovery1ymin
=Cardiacyoutputy-yCORRECTyANSWER-

Questiony3yofy4
Theydicroticynotchycorrespondsytoywhichycardiovascularyaction?
Startyofybloodyflowyintoytheypulmonaryyvasculature
Openingyofytheypulmonicyvalve
Closureyofytheyaorticyvalve
Contractionyofytheyventriclesy-yCORRECTyANSWER-Closureyofytheyaorticyvalve
Theydicroticynotchyoccursyduringyclosureyofytheyaorticyvalve.

,Questiony4yofy4
Whichychangesywouldyindicateythatyanyintraarterialybloodypressureywaveformyisyun
derdamped?ySelectyallythatyapply.yOne,ysome,yoryallyresponsesymayybeycorrect.
Falselyyhighysystolicyreading
Increasedydicroticynotch
Narrowyupwardysystolicypeak
Prolongedydiastolicycomplex
Falselyylowydiastolicyreadingy-yCORRECTyANSWER-Falselyyhighysystolicyreading
Underdampingyofytheysignalycausesyayfalselyyhighysystolicyreading,ywhenycomparedyt
oytheypatient'sycuffybloodypressure.

Narrowyupwardysystolicypeak
Underdampingycausesynarrowingyofytheyupwardysystolicypeak.

Questiony1yofy4
Matchytheycentralyvenousycatheterysiteytoytheycorrespondingyadvantages.
Easiestytoycannulize;ysmallyriskyofypneumothorax
Internalyjugular
Lowestyinfectionyrate;yleastypatientydiscomfortyfromytheycatheter
Subclavian
Noycurvesyinyinsertionyroute;yhighybloodyflowyrate
Femoraly-yCORRECTyANSWER-

Questiony2yofy4
Inywhichyorderywouldytheynurseyperformytheystepsytoyremoveyaycentralyvenousycath
eter?
CorrectyAnswery
Exactly!
Placeytheypatientyinyaysupineyposition.y
Askytheypatientytoytakeyaydeepybreathyandyholdyit.y
Removeytheycentralyvenousycatheteryinyayslow,ysteadyymotion.y
Applyyanyocclusiveydressingytoytheysite.y-yCORRECTyANSWER-
Ityisyimportantytoypreventyairyembolismsyandybleedingywhileyremovingytheycentralyv
enousycatheter.yTheynurseywouldyplaceytheypatientyflatyandyaskytheypatientytoytakeyay
deepybreathyduringyremovalytoypreventyanyairyembolismyfromyoccurring.

Questiony3yofy4
Matchytheyelementyofytheycentralyvenousypressureywaveformytoytheycorrespondingyc
ardiacyevent.
CorrectyAnswery
Exactly!
atrialyrelaxation
xydescent
bulgingyofyclosedytricuspidyvalve
cywave
atrialyfilling

,vywave
beginningyofyventricularyfilling
yydescenty-yCORRECTyANSWER-

Questiony4yofy4
Whichyconditionywouldyproduceyaycannonywaveyonytheycentralyvenousypressureywav
eform?
Junctionalyrhythm
Tricuspidyvalveyinsufficiency
Rightyventricularyfailure
Atrialyfibrillationy-yCORRECTyANSWER-Junctionalyrhythm
Ayjunctionalyrhythmycausesyretrogradeyconductionyofytheyatria,ywhichyproducesyayca
nnonywave.

Questiony1yofy6
Theynurseycanyuseyaypulmonaryyarteryy(PA)ycatheterytoyassessywhichymeasurement?
ySelectyallythatyapply.yOne,ysome,yoryallyresponsesymayybeycorrect.

Wedgeypressure
Pulmonaryyarteryysystolicypressure
Cardiacyoutput
Systemicydiastolicypressure
Mixedyvenousyoxygenysaturationy-yCORRECTyANSWER-Wedgeypressure
Pulmonaryyarteryysystolicypressure
Cardiacyoutput
Mixedyvenousyoxygenysaturation

Questiony2yofy6
CorrectyAnswery
Exactly!
Whatyisytheycardiacyoutputyinylitersyperyminuteyforyaypatientywithyayheartyrateyofy75y
bpmyandyaystrokeyvolumeyofy65ymL?yRoundytoytheynearestywholeynumberywithynoyp
unctuationyoryunits.y
5
yL/miny-yCORRECTyANSWER-5

Cardiacyoutputyisyequalytoyheartyrateymultipliedybyystrokeyvolume.yTherefore,y75ymu
ltipliedybyy65yisy4,875ymLyory4.875yL.yAfteryrounding,ytheyansweryisy5yL/min.

Questiony3yofy6
Matchytheypulmonaryyarteryycatheterymeasurementywithytheycorrespondingydescrip
tion.
Preloadyinyrightysideyofytheyheart
=Centralyvenousypressure
Preloadyinyleftysideyofytheyheart
=Pulmonaryyarteryyocclusionypressurey-yCORRECTyANSWER-

Questiony4yofy6

, BasedyonytheyFrank-
Starlingylaw,ywhichychangeywouldytheynurseyexpectytoyseeyafteryaymoderateyamounty
ofyintravenousyfluidsyareyadministered?
Decreaseyinypreload
Increaseyinycardiacyoutput
Decreaseyinymyocardialyfiberystretch
Increaseyinyheartyratey-yCORRECTyANSWER-Increaseyinycardiacyoutput
Cardiacyoutputyincreasesyasyleftyventricleyvolumeyandymyocardialyfiberystretchyincre
asesyfromytheyextrayfluid.

Questiony5yofy6
Matchytheycardiacyconditionywithytheycorrespondingychangeyinypulmonaryyarteryypr
essures.
Increasedyleftyatrialypressure
=Mitralystenosis
Artificiallyyelevatedymeanywedgeypressure
=Mitralyregurgitation
EqualizedyPAOPyandyPADP
=Left-sidedyheartyfailurey-yCORRECTyANSWER-

Questiony6yofy6
WhichymedicationywouldytheynurseyadministerytoyaypatientywithyaySVRyofy1,600ydyn∙
sec∙cm−5?
Fluidyvolume
Norepinephrine
Nitroglycerin
Epinephriney-yCORRECTyANSWER-Nitroglycerin
High-
doseynitroglycerinyisyusedywhenytheySVRyisyelevatedy(greaterythany1,200ydyn∙sec∙cm
−5).

Questiony1yofy5
Matchytheypulmonaryyarteryycatheterylumenywithytheycorrespondingyfunction.
IVyinfusion,yCVPymeasurement,ywithdrawalyofyvenousybloodysamples
=Rightyatrialylumen
Recordypressuresywithinytheypulmonaryyartery
=Distalypulmonaryyarteryylumen
Inflatedyduringyinsertion;yusedytoyassessyPAOP
=Balloonylumen
Usedytoymeasureychangesyinybloodytemperatureytoyassessycardiacyoutput
=Thermistorylumeny-yCORRECTyANSWER-

Questiony2yofy5
Theynurseyisyassistingywithyinsertionyofyaypulmonaryyarteryycatheter.yInywhichyorder
ywouldytheynurseyexpectytheycatheterytoyfollow?

CorrectyAnswery