CRITICAL CARE TestBank Exam 2
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Chapterg08:gHemodynamicgMonitoring
1. Thegnursegisgcaringgforgag100-
kggpatientgbeinggmonitoredgwithgagpulmonarygarterygcatheter.gThegnursegassessesgagbloodgpressuregofg90/60gmmgHg,gheartgrateg110gbeats/min,grespi
rationsg36/min,goxygengsaturationgofg89%gong3gLgofgoxygengviagnasalgcannula.gBilateralgcracklesgaregaudiblegupongauscultation.gWhichghemodynamic
gvaluegrequiresgimmediategactiongbygthegnurse?
a. Cardiacgindexg(CI)gofg1.2gL/min/m3
b. Cardiacgoutputg(CO)gofg4gL/min
c. Pulmonarygvasculargresistanceg(PVR)gofg80gdynes/sec/cm–5
d. Systemicgvasculargresistanceg(SVR)gofg1400gdynes/sec/cm–5
Agcardiacgindexgofg1.2gL/min/m3gcombinedgwithgthegidentifiedgclinicalgassessmentgfindingsgindicategaglowgcardiacgoutputgwithgfluidgoverloadg(bilateralgc
rackles),grequiringgintervention.gThegremainingghemodynamicgvaluesgaregwithingnormalglimits:gcardiacgoutputgofg4gL/min;gpulmonarygvasculargresistanc
egofg80gdynes/sec/cm–5;gandgthegsystemicgvasculargresistancegofg1400gdynes/sec/cm–5.
2. Whilegcaringgforgagpatientgwithgagsmallgbowelgobstruction,gthegnursegassessesgagpulmonarygarterygocclusiongpressureg(PAOP)gofg1gmmgHggandgho
urlygurinegoutputgofg5gmL.gThegnurseganticipatesgwhichgtherapeuticgintervention?
a. Diuretics
b. Intravenousgfluids
c. Negativeginotropicgagents
d. Vasopressors
Lowgpulmonarygarterygocclusiongpressuresgusuallygindicategvolumegdepletion,gsogintravenousgfluidsgwouldgbegindicated.gAgnormalghourlygurine
goutputgisg1gmL/kggorgatgleastg30gmL/hour,gsogthisgisganothergindicationgthatgthegpatientgisgvolumegdepleted.gAdministrationgofgdiureticsgwouldgworsengt
hegpatient’sgvolumegstatus.gNegativeginotropesgwouldgnotgimprovegthegpatient’sgvolumegstatus.gVasopressorsgwillgincreasegbloodgpressuregbutgaregco
ntraindicatedgingaglowgvolumegstate.
3. Thegnursegisgcaringgforgagpatientgwhoghasghadgangarterialglineginserted.gTogreducegthegriskgofgcomplications,gwhatgisgthegprioritygnursinggintervention?
a. Applygagpressuregdressinggtogtheginsertiongsite.
b. Ensuregthatgallgtubinggconnectionsgaregtightened.
c. Obtaingagportablegx-raygtogconfirmgplacement.
d. Restraingthegaffectedgextremitygforg24ghours.
Loosegconnectionsginghemodynamicgmonitoringgtubinggcangleadgtoghemorrhage,gagmajorgcomplicationgofgarterialgpressuregmonitoring.gApplicationgofga
gpressuregdressinggisgrequiredgonlygupongarterialglinegremoval.gBloodgreturngisgadequategconfirmationgofgarterialglinegplacement;gradiographygisg
notgperformedgtogconfirmgarterialglinegplacement.gNeutralgpositioninggofgthegextremitygandgusegofgangarmgboard,gwithoutglimbgrestraint,gisgthegstandardg
ofgcare.
4. Whilegcaringgforgagpatientgwithgagpulmonarygarterygcatheter,gthegnursegnotesgthegpulmonarygarterygocclusiongpressureg(PAOP)gtogbegsignificantlyghi
ghergthangpreviouslygrecordedgvalues.gThegnursegassessesgrespirationsgtogbegunlaboredgatg16gbreaths/min,goxygengsaturationgofg98%gong3gLgofgox
ygengviagnasalgcannula,gandglungsgcleargtogauscultationgbilaterally.gWhatgisgthegprioritygnursinggaction?
a. Increasegsupplementalgoxygengandgnotifygrespiratorygtherapy.
b. Notifygthegprovidergimmediatelygofgthegassessmentgfindings.
c. Obtaingagstatgchestgx-raygfilmgtogverifygpropergcathetergplacement.
d. Zerogreferencegandglevelgthegcathetergatgthegphlebostaticgaxis.
Aghemodynamicgvaluegnotgsupportedgbygclinicalgassessmentgshouldgbegtreatedgasgquestionable.gTogensuregthegaccuracygofghemodynamicgreadings,gt
hegcathetergtransducergsystemgmustgbegleveledgatgthegphlebostaticgaxisgandgzerogreferenced.gIngthisgexample,gthegcathetergtransducergsystemgm
aygbeglowergthangthegphlebostaticgaxis,gresultinggingerroneouslyghighergpressures.gClinicalgmanifestationsgdognotgsupportgincreasinggsuppleme
ntalgoxygen.gClinicalgmanifestationsgdognotgwarrantgprovidergintervention;gaberrantgvaluesgshouldgbeginvestigatedgfurther.gAngaberrantgvaluegwarrantsgf
urtherginvestigation,gwhichgincludesgzerogreferencinggandgcheckinggtheglevelgasganginitialgmeasure.gAgchestgx-raygstudygisgnotgwarrantedgatgthisgtime.
5. Agpatientgisgadmittedgtogtheghospitalgwithgmultiplegtraumagandgextensivegbloodgloss.gThegnursegassessesgvitalgsignsgtogbegBPg80/50gmmgHg,gheartgrate
–
g135gbeats/min,grespirationsg36gbreaths/min,gcardiacgoutputg(CO)gofg2gL/min,gsystemicgvasculargresistancegofg3000gdynes/sec/cm
5
,gandgaghematocritgofg20%.gThegnurseganticipatesgadministrationgofgwhichgthegfollowinggtherapiesgorgmedications?
a. Bloodgtransfusion
b. Furosemide
c. Dobutamineginfusion
d. Dopamineghydrochlorideginfusion
Bothghemodynamicgparametersgandgthegreportedghematocritgvaluegindicateghypovolemiagandgbloodglossgrequiringgvolumegresuscitationgwithgbloodgpr
oducts.gFurosemidegadministrationgwillgworsengfluidgvolumegstatus.gInotropicgagentsgwillgnotgcorrectgthegunderlyinggfluidgvolumegdeficitgandganemia.gV
asoconstrictorsgaregcontraindicatedgingagvolume-depletedgstate.
6. Aftergpulmonarygarterygcatheterginsertion,gthegnursegassessesgagpulmonarygarterygpressuregofg45/25gmmgHg,gagpulmonarygarterygocclusiongpress
ureg(PAOP)gofg20gmmgHg,gagcardiacgoutputgofg2.6gL/mingandgagcardiacgindexgofg1.9gL/min/m2.gWhichgprovidergordergisgofgtheghighestgpriority?
a. Applyg50%goxygengviagVenturigmask.
b. Insertgangindwellinggurinarygcatheter.
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Thegpulmonarygpressuresgareghighergthangnormal,gindicatinggelevatedgpreload,gandgthegcardiacgindexgandgoutputgvaluesgareglow.gThegprioritygordergfor
gthegnursegtogimplementgisgtogbegingagdobutamineginfusiongtogimprovegcardiacgoutput,gpossiblygreducinggpulmonarygarterygocclusiongpressures.gThego
thergtreatmentsgmaygbegimportant,gdependinggongothergpatientgdata,gbutgthegdobutamineginfusiongisgthegmostgimportantgatgthisgtime.
7. Thegnursegisgcaringgforgagpatientgwithgagleftgsubclaviangcentralgvenousgcatheterg(CVC)gandgagleftgradialgarterialgline.gWhichgassessmentgfindinggby
gthegnursegrequiresgimmediategaction?
a. Agdampenedgarterialglinegwaveform
b. Numbnessgandgtinglinggingthegleftghand
c. Slightgbloodygdrainagegatgsubclavianginsertiongsite
d. Slightgrednessgatgsubclavianginsertiongsite
Numbnessgandgtinglinggingthegleftghand,gwhichgisgtheglocationgofgangarterialgcatheter,gindicatesgpossiblegneurovasculargcompromisegandgrequiresgimm
ediategaction.gAgdampenedgwaveformgcangindicategproblemsgwithgarterialglinegpatencygbutgisgnotgangemergentgsituation.gSlightgbloodygdrainagegatgtheg
subclavianginsertiongsitegisgnotgangunusualgfinding.gSlightgrednessgatgtheginsertiongsite,gwhilegofgconcern,gdoesgnotgrequiregimmediategaction.
8. Thegprovidergwritesgangordergtogdiscontinuegagpatient’sgleftgradialgarterialgline.gWhengdiscontinuinggthegpatient’sginvasivegline,gwhatgisgthegprioritygnur
singgaction?
a. Applygangairgocclusiongdressinggtoginsertiongsite.
b. Applygpressuregtogtheginsertiongsitegforg5gminutes.
c. Elevategthegaffectedglimbgongpillowsgforg24ghours.
d. Keepgthegpatient’sgwristgingagneutralgposition.
Upongremovalgofganginvasivegarterialgline,gadequategpressuregmustgbegappliedgforgatgleastg5gminutesgtogensuregadequateghemostasis.gApplicationgofga
ngairgocclusiongdressinggisgnotgthegstandardgofgcaregfollowinggremovalgofgangarterialgline.gElevationgofgthegaffectedglimbgfollowinggremovalgofgangarterialg
linegisgnotgagnecessarygintervention.gNeutralgwristgpositiongisgoptimumgwhilegthegcathetergisgingplacegbutgunnecessarygaftergcathetergdiscontinuation.
9. Followingginsertiongofgagcentralgvenousgcatheter,gthegnursegobtainsgagstatgchestgx-
raygfilmgtogverifygpropergcathetergplacement.gThegradiologistgreportsgtogthegnurse:g“Thegtipgofgthegcathetergisglocatedgingthegsuperiorgvenagcava.”gWh
atgisgthegbestginterpretationgofgthesegresultsgbygthegnurse?
a. Thegcathetergisgnotgpositionedgcorrectlygandgshouldgbegremoved.
b. Thegcathetergpositiongincreasesgthegriskgofgventriculargdysrhythmias.
c. Thegdistalgtipgofgthegcathetergisgingthegappropriategposition.
d. Thegphysiciangshouldgbegcalledgtogadvancegthegcathetergintogthegpulmonarygartery.
X-
raygresultsgindicategpropergpositiongofgthegcatheter.gThegtipgofgthegcentralgvenousgcathetergshouldgrestgjustgabovegthegrightgatriumgingthegsuperi
orgvenagcava.gThegcentralgvenousgcathetergisgpositionedgcorrectlygingthegsuperiorgvenagcava.gDysrhythmiasgoccurgifgthegcathetergmigratesgtogthegrigh
tgventricle.gCentralgvenousgcathetersgaregplacedgintoggreatgvesselsgofgthegvenousgsystemgandgnotgadvancedgintogthegpulmonarygartery.
10. Whileginflatinggthegballoongofgagpulmonarygarterygcatheterg(PAC)gwithg1.0gmLgofgairgtogobtaingagpulmonarygarterygocclusiongpressureg(PAOP),gthegn
ursegencountersgresistance.gWhatgisgthegbestgnursinggaction?
a. Addgangadditionalg0.5gmLgofgairgtogthegballoongandgrepeatgthegprocedure.
b. Advancegthegcathetergwithgthegballoongdeflatedgandgrepeatgthegprocedure.
c. Deflategthegballoongandgobtaingagchestgx-raygstudygtogdetermineglinegplacement.
d. Lockgthegballoongingtheginflatedgposition,gandgflushgthegdistalgportgofgthegPACgwithgnormalgsaline.
BalloonginflationgshouldgnevergbegforcedgbecausegthegPACgmayghavegmigratedgfarthergintogthegpulmonarygartery,gcreatinggresistancegtogballoonginflati
on.gVerificationgofgproperglinegplacementgisgwarrantedgtogavoidgpulmonarygarterygrupture.gIngaddition,gthegPACgwaveformgshouldgbegobservedgt
ogassistgingidentifyingglocationgofgthegtipgofgthegPAC.gIngthisgscenario,gaddinggadditionalgairgtogthegballoongwillgfurthergriskgpulmonarygarterygrupture.gAd
vancinggagpulmonarygarterygcathetergisgnotgwithingthegnurse’sgscopegofgpractice.gFlushinggthegdistalgportgwithgsalinegmaygbegindicatedgtogensuregpaten
cy;ghowever,gthegballoongofgthegPACgshouldgnevergbeglockedgingtheginflatedgpositiongasgrupturegofgthegpulmonarygarterygmaygoccur.
11. Thegnursegisgcaringgforgagpatientgfollowingginsertiongofgagleftgsubclaviangcentralgvenousgcatheterg(CVC).gWhichgassessmentgfindingg2ghoursgafterginser
tiongbygthegnursegwarrantsgimmediategaction?
a. Diminishedgbreathgsoundsgovergleftglunggfield
b. Localizedgpaingatgcatheterginsertiongsite
c. Measuredgcentralgvenousgpressuregofg5gmmgHg
d. Slightgbloodygdrainagegaroundginsertiongsite
Diminishedgbreathsgsoundsgovergtheglunggfieldgongthegsamegsidegofgtheglineginsertiongsitegmaygbegindicativegofgagpneumothorax.gAgpneumo
thorax,gwhichgcangdevelopgslowly,gisgagmajorgcomplicationgfollowingginsertiongofgcentralglinesgwhengthegsubclaviangroutegisgused.gLocalizedgpaingatgcath
eterginsertiongsitegisgnotgthegimmediategprioritygingthisgscenario.gAgmeasuredgcentralgvenousgpressuregofg5gmmgHggisgnormal.gSlightgbloodygdrainagegatg
theginsertiongsitegsoongaftergthegproceduregdoesgnotgrequiregimmediategaction.
12. Thegnursegisgcaringgforgagmechanicallygventilatedgpatientgwithgagpulmonarygarterygcathetergwhogisgreceivinggcontinuousgenteralgtubegfeedings.gWhen
a. Dognotgdocumentghemodynamicgvaluesguntilgthegpatientgcangbegplacedgingthegsupinegposition.
,CRI
b. Levelgandgzerogreferencegthegair-fluidginterfacegofgthegtransducergwithgthegpatientgingthegsupinegpositiongandgrecordghemodynamicgvalues.
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Chapterg08:gHemodynamicgMonitoring
1. Thegnursegisgcaringgforgag100-
kggpatientgbeinggmonitoredgwithgagpulmonarygarterygcatheter.gThegnursegassessesgagbloodgpressuregofg90/60gmmgHg,gheartgrateg110gbeats/min,grespi
rationsg36/min,goxygengsaturationgofg89%gong3gLgofgoxygengviagnasalgcannula.gBilateralgcracklesgaregaudiblegupongauscultation.gWhichghemodynamic
gvaluegrequiresgimmediategactiongbygthegnurse?
a. Cardiacgindexg(CI)gofg1.2gL/min/m3
b. Cardiacgoutputg(CO)gofg4gL/min
c. Pulmonarygvasculargresistanceg(PVR)gofg80gdynes/sec/cm–5
d. Systemicgvasculargresistanceg(SVR)gofg1400gdynes/sec/cm–5
Agcardiacgindexgofg1.2gL/min/m3gcombinedgwithgthegidentifiedgclinicalgassessmentgfindingsgindicategaglowgcardiacgoutputgwithgfluidgoverloadg(bilateralgc
rackles),grequiringgintervention.gThegremainingghemodynamicgvaluesgaregwithingnormalglimits:gcardiacgoutputgofg4gL/min;gpulmonarygvasculargresistanc
egofg80gdynes/sec/cm–5;gandgthegsystemicgvasculargresistancegofg1400gdynes/sec/cm–5.
2. Whilegcaringgforgagpatientgwithgagsmallgbowelgobstruction,gthegnursegassessesgagpulmonarygarterygocclusiongpressureg(PAOP)gofg1gmmgHggandgho
urlygurinegoutputgofg5gmL.gThegnurseganticipatesgwhichgtherapeuticgintervention?
a. Diuretics
b. Intravenousgfluids
c. Negativeginotropicgagents
d. Vasopressors
Lowgpulmonarygarterygocclusiongpressuresgusuallygindicategvolumegdepletion,gsogintravenousgfluidsgwouldgbegindicated.gAgnormalghourlygurine
goutputgisg1gmL/kggorgatgleastg30gmL/hour,gsogthisgisganothergindicationgthatgthegpatientgisgvolumegdepleted.gAdministrationgofgdiureticsgwouldgworsengt
hegpatient’sgvolumegstatus.gNegativeginotropesgwouldgnotgimprovegthegpatient’sgvolumegstatus.gVasopressorsgwillgincreasegbloodgpressuregbutgaregco
ntraindicatedgingaglowgvolumegstate.
3. Thegnursegisgcaringgforgagpatientgwhoghasghadgangarterialglineginserted.gTogreducegthegriskgofgcomplications,gwhatgisgthegprioritygnursinggintervention?
a. Applygagpressuregdressinggtogtheginsertiongsite.
b. Ensuregthatgallgtubinggconnectionsgaregtightened.
c. Obtaingagportablegx-raygtogconfirmgplacement.
d. Restraingthegaffectedgextremitygforg24ghours.
Loosegconnectionsginghemodynamicgmonitoringgtubinggcangleadgtoghemorrhage,gagmajorgcomplicationgofgarterialgpressuregmonitoring.gApplicationgofga
gpressuregdressinggisgrequiredgonlygupongarterialglinegremoval.gBloodgreturngisgadequategconfirmationgofgarterialglinegplacement;gradiographygisg
notgperformedgtogconfirmgarterialglinegplacement.gNeutralgpositioninggofgthegextremitygandgusegofgangarmgboard,gwithoutglimbgrestraint,gisgthegstandardg
ofgcare.
4. Whilegcaringgforgagpatientgwithgagpulmonarygarterygcatheter,gthegnursegnotesgthegpulmonarygarterygocclusiongpressureg(PAOP)gtogbegsignificantlyghi
ghergthangpreviouslygrecordedgvalues.gThegnursegassessesgrespirationsgtogbegunlaboredgatg16gbreaths/min,goxygengsaturationgofg98%gong3gLgofgox
ygengviagnasalgcannula,gandglungsgcleargtogauscultationgbilaterally.gWhatgisgthegprioritygnursinggaction?
a. Increasegsupplementalgoxygengandgnotifygrespiratorygtherapy.
b. Notifygthegprovidergimmediatelygofgthegassessmentgfindings.
c. Obtaingagstatgchestgx-raygfilmgtogverifygpropergcathetergplacement.
d. Zerogreferencegandglevelgthegcathetergatgthegphlebostaticgaxis.
Aghemodynamicgvaluegnotgsupportedgbygclinicalgassessmentgshouldgbegtreatedgasgquestionable.gTogensuregthegaccuracygofghemodynamicgreadings,gt
hegcathetergtransducergsystemgmustgbegleveledgatgthegphlebostaticgaxisgandgzerogreferenced.gIngthisgexample,gthegcathetergtransducergsystemgm
aygbeglowergthangthegphlebostaticgaxis,gresultinggingerroneouslyghighergpressures.gClinicalgmanifestationsgdognotgsupportgincreasinggsuppleme
ntalgoxygen.gClinicalgmanifestationsgdognotgwarrantgprovidergintervention;gaberrantgvaluesgshouldgbeginvestigatedgfurther.gAngaberrantgvaluegwarrantsgf
urtherginvestigation,gwhichgincludesgzerogreferencinggandgcheckinggtheglevelgasganginitialgmeasure.gAgchestgx-raygstudygisgnotgwarrantedgatgthisgtime.
5. Agpatientgisgadmittedgtogtheghospitalgwithgmultiplegtraumagandgextensivegbloodgloss.gThegnursegassessesgvitalgsignsgtogbegBPg80/50gmmgHg,gheartgrate
–
g135gbeats/min,grespirationsg36gbreaths/min,gcardiacgoutputg(CO)gofg2gL/min,gsystemicgvasculargresistancegofg3000gdynes/sec/cm
5
,gandgaghematocritgofg20%.gThegnurseganticipatesgadministrationgofgwhichgthegfollowinggtherapiesgorgmedications?
a. Bloodgtransfusion
b. Furosemide
c. Dobutamineginfusion
d. Dopamineghydrochlorideginfusion
Bothghemodynamicgparametersgandgthegreportedghematocritgvaluegindicateghypovolemiagandgbloodglossgrequiringgvolumegresuscitationgwithgbloodgpr
oducts.gFurosemidegadministrationgwillgworsengfluidgvolumegstatus.gInotropicgagentsgwillgnotgcorrectgthegunderlyinggfluidgvolumegdeficitgandganemia.gV
asoconstrictorsgaregcontraindicatedgingagvolume-depletedgstate.
6. Aftergpulmonarygarterygcatheterginsertion,gthegnursegassessesgagpulmonarygarterygpressuregofg45/25gmmgHg,gagpulmonarygarterygocclusiongpress
ureg(PAOP)gofg20gmmgHg,gagcardiacgoutputgofg2.6gL/mingandgagcardiacgindexgofg1.9gL/min/m2.gWhichgprovidergordergisgofgtheghighestgpriority?
a. Applyg50%goxygengviagVenturigmask.
b. Insertgangindwellinggurinarygcatheter.
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c. Begingagdobutamineginfusion.
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Thegpulmonarygpressuresgareghighergthangnormal,gindicatinggelevatedgpreload,gandgthegcardiacgindexgandgoutputgvaluesgareglow.gThegprioritygordergfor
gthegnursegtogimplementgisgtogbegingagdobutamineginfusiongtogimprovegcardiacgoutput,gpossiblygreducinggpulmonarygarterygocclusiongpressures.gThego
thergtreatmentsgmaygbegimportant,gdependinggongothergpatientgdata,gbutgthegdobutamineginfusiongisgthegmostgimportantgatgthisgtime.
7. Thegnursegisgcaringgforgagpatientgwithgagleftgsubclaviangcentralgvenousgcatheterg(CVC)gandgagleftgradialgarterialgline.gWhichgassessmentgfindinggby
gthegnursegrequiresgimmediategaction?
a. Agdampenedgarterialglinegwaveform
b. Numbnessgandgtinglinggingthegleftghand
c. Slightgbloodygdrainagegatgsubclavianginsertiongsite
d. Slightgrednessgatgsubclavianginsertiongsite
Numbnessgandgtinglinggingthegleftghand,gwhichgisgtheglocationgofgangarterialgcatheter,gindicatesgpossiblegneurovasculargcompromisegandgrequiresgimm
ediategaction.gAgdampenedgwaveformgcangindicategproblemsgwithgarterialglinegpatencygbutgisgnotgangemergentgsituation.gSlightgbloodygdrainagegatgtheg
subclavianginsertiongsitegisgnotgangunusualgfinding.gSlightgrednessgatgtheginsertiongsite,gwhilegofgconcern,gdoesgnotgrequiregimmediategaction.
8. Thegprovidergwritesgangordergtogdiscontinuegagpatient’sgleftgradialgarterialgline.gWhengdiscontinuinggthegpatient’sginvasivegline,gwhatgisgthegprioritygnur
singgaction?
a. Applygangairgocclusiongdressinggtoginsertiongsite.
b. Applygpressuregtogtheginsertiongsitegforg5gminutes.
c. Elevategthegaffectedglimbgongpillowsgforg24ghours.
d. Keepgthegpatient’sgwristgingagneutralgposition.
Upongremovalgofganginvasivegarterialgline,gadequategpressuregmustgbegappliedgforgatgleastg5gminutesgtogensuregadequateghemostasis.gApplicationgofga
ngairgocclusiongdressinggisgnotgthegstandardgofgcaregfollowinggremovalgofgangarterialgline.gElevationgofgthegaffectedglimbgfollowinggremovalgofgangarterialg
linegisgnotgagnecessarygintervention.gNeutralgwristgpositiongisgoptimumgwhilegthegcathetergisgingplacegbutgunnecessarygaftergcathetergdiscontinuation.
9. Followingginsertiongofgagcentralgvenousgcatheter,gthegnursegobtainsgagstatgchestgx-
raygfilmgtogverifygpropergcathetergplacement.gThegradiologistgreportsgtogthegnurse:g“Thegtipgofgthegcathetergisglocatedgingthegsuperiorgvenagcava.”gWh
atgisgthegbestginterpretationgofgthesegresultsgbygthegnurse?
a. Thegcathetergisgnotgpositionedgcorrectlygandgshouldgbegremoved.
b. Thegcathetergpositiongincreasesgthegriskgofgventriculargdysrhythmias.
c. Thegdistalgtipgofgthegcathetergisgingthegappropriategposition.
d. Thegphysiciangshouldgbegcalledgtogadvancegthegcathetergintogthegpulmonarygartery.
X-
raygresultsgindicategpropergpositiongofgthegcatheter.gThegtipgofgthegcentralgvenousgcathetergshouldgrestgjustgabovegthegrightgatriumgingthegsuperi
orgvenagcava.gThegcentralgvenousgcathetergisgpositionedgcorrectlygingthegsuperiorgvenagcava.gDysrhythmiasgoccurgifgthegcathetergmigratesgtogthegrigh
tgventricle.gCentralgvenousgcathetersgaregplacedgintoggreatgvesselsgofgthegvenousgsystemgandgnotgadvancedgintogthegpulmonarygartery.
10. Whileginflatinggthegballoongofgagpulmonarygarterygcatheterg(PAC)gwithg1.0gmLgofgairgtogobtaingagpulmonarygarterygocclusiongpressureg(PAOP),gthegn
ursegencountersgresistance.gWhatgisgthegbestgnursinggaction?
a. Addgangadditionalg0.5gmLgofgairgtogthegballoongandgrepeatgthegprocedure.
b. Advancegthegcathetergwithgthegballoongdeflatedgandgrepeatgthegprocedure.
c. Deflategthegballoongandgobtaingagchestgx-raygstudygtogdetermineglinegplacement.
d. Lockgthegballoongingtheginflatedgposition,gandgflushgthegdistalgportgofgthegPACgwithgnormalgsaline.
BalloonginflationgshouldgnevergbegforcedgbecausegthegPACgmayghavegmigratedgfarthergintogthegpulmonarygartery,gcreatinggresistancegtogballoonginflati
on.gVerificationgofgproperglinegplacementgisgwarrantedgtogavoidgpulmonarygarterygrupture.gIngaddition,gthegPACgwaveformgshouldgbegobservedgt
ogassistgingidentifyingglocationgofgthegtipgofgthegPAC.gIngthisgscenario,gaddinggadditionalgairgtogthegballoongwillgfurthergriskgpulmonarygarterygrupture.gAd
vancinggagpulmonarygarterygcathetergisgnotgwithingthegnurse’sgscopegofgpractice.gFlushinggthegdistalgportgwithgsalinegmaygbegindicatedgtogensuregpaten
cy;ghowever,gthegballoongofgthegPACgshouldgnevergbeglockedgingtheginflatedgpositiongasgrupturegofgthegpulmonarygarterygmaygoccur.
11. Thegnursegisgcaringgforgagpatientgfollowingginsertiongofgagleftgsubclaviangcentralgvenousgcatheterg(CVC).gWhichgassessmentgfindingg2ghoursgafterginser
tiongbygthegnursegwarrantsgimmediategaction?
a. Diminishedgbreathgsoundsgovergleftglunggfield
b. Localizedgpaingatgcatheterginsertiongsite
c. Measuredgcentralgvenousgpressuregofg5gmmgHg
d. Slightgbloodygdrainagegaroundginsertiongsite
Diminishedgbreathsgsoundsgovergtheglunggfieldgongthegsamegsidegofgtheglineginsertiongsitegmaygbegindicativegofgagpneumothorax.gAgpneumo
thorax,gwhichgcangdevelopgslowly,gisgagmajorgcomplicationgfollowingginsertiongofgcentralglinesgwhengthegsubclaviangroutegisgused.gLocalizedgpaingatgcath
eterginsertiongsitegisgnotgthegimmediategprioritygingthisgscenario.gAgmeasuredgcentralgvenousgpressuregofg5gmmgHggisgnormal.gSlightgbloodygdrainagegatg
theginsertiongsitegsoongaftergthegproceduregdoesgnotgrequiregimmediategaction.
12. Thegnursegisgcaringgforgagmechanicallygventilatedgpatientgwithgagpulmonarygarterygcathetergwhogisgreceivinggcontinuousgenteralgtubegfeedings.gWhen
a. Dognotgdocumentghemodynamicgvaluesguntilgthegpatientgcangbegplacedgingthegsupinegposition.
,CRI
b. Levelgandgzerogreferencegthegair-fluidginterfacegofgthegtransducergwithgthegpatientgingthegsupinegpositiongandgrecordghemodynamicgvalues.
