NRNP 6566 WEEK 3 KNOWLEDGE CHECK 2026/2027 |
Advanced Care of Adults in Acute Settings I | Questions and
Verified Answers | Pass Guaranteed - A+ Graded
Reading Hemodynamic Signals & Waveforms (Hemodynamic Monitoring Principles)
Q1: You're looking at an arterial waveform that seems exaggerated with a systolic peak
higher than expected and a beat-to-beat variation that looks almost jittery. The dicrotic
notch appears absent. When you perform the square wave test, you see a large
overshoot followed by oscillation before settling. This suggests:
A. The system is properly damped and ready for accurate measurement
B. The transducer is positioned too high relative to the patient's phlebostatic axis
C. The system is underdamped, leading to falsely elevated systolic readings [CORRECT]
D. The catheter is kinked or occluded, causing an overdamped waveform
Correct Answer: C
Rationale: An underdamped system oscillates excessively, showing overshoot in the
square wave test and falsely elevated systolic pressures while diastolic may read low.
The dicrotic notch often disappears or looks exaggerated. You'd need to flush the
system or remove air bubbles. A kinked catheter would show a slurred upstroke and
loss of detail (overdamped), not oscillation.
,Q2: A properly zeroed central venous pressure (CVP) catheter measures right atrial
pressure. In a healthy adult without mechanical ventilation or cardiac disease, you'd
expect this value to fall within which range?
A. 0-2 mmHg
B. 2-6 mmHg [CORRECT]
C. 8-12 mmHg
D. 15-20 mmHg
Correct Answer: B
Rationale: Normal CVP is 2-6 mmHg (or 2-8 in some texts). Values below 2 suggest
hypovolemia, while values above 6-8 may indicate volume overload or right heart
dysfunction. 8-12 is the normal range for PAOP (wedge pressure), and 15-20 would
indicate significant right heart failure or volume overload.
Q3: You've floated a pulmonary artery catheter and obtained a pulmonary artery
occlusion pressure (PAOP) reading of 24 mmHg in a patient with acute myocardial
infarction. The patient has crackles bilaterally and is dyspneic. Knowing that PAOP
reflects left ventricular end-diastolic pressure in the absence of mitral valve disease,
what does this reading suggest?
A. The patient is severely volume depleted and needs aggressive fluid resuscitation
B. There is likely left ventricular dysfunction with elevated filling pressures [CORRECT]
C. The catheter is in the wedged position and should be advanced further
D. This is a normal finding immediately following myocardial infarction
,Correct Answer: B
Rationale: A PAOP >18 mmHg (some say >15) suggests elevated left ventricular filling
pressures consistent with cardiogenic pulmonary edema. In this scenario with crackles
and dyspnea, the elevated PAOP indicates LV failure. You would not give fluids; you
might need diuresis or afterload reduction. The catheter is properly wedged to obtain
this reading.
Q4: Your patient has a continuous mixed venous oxygen saturation (SvO2) monitoring
via pulmonary artery catheter. Over the past hour, the SvO2 has dropped from 72% to
55% despite stable arterial oxygen saturation. Which scenario best explains this
desaturation?
A. The patient is receiving too much supplemental oxygen
B. Either oxygen delivery has decreased or oxygen consumption has increased
[CORRECT]
C. The patient has developed a right-to-left intracardiac shunt
D. This represents a calibration error of the catheter
Correct Answer: B
Rationale: SvO2 reflects the balance between oxygen delivery (DO2) and oxygen
consumption (VO2). A drop indicates either decreased delivery (low cardiac output,
anemia, hypoxemia) or increased consumption (sepsis, shivering, agitation). A
right-to-left shunt would lower arterial saturation, not specifically venous. While
calibration errors occur, clinical correlation is needed.
Q5: When measuring cardiac output using the thermodilution method via PAC, which
factor would most likely result in a falsely low cardiac output reading?
, A. Injecting the room-temperature saline too rapidly through the proximal port
B. Patient shivering during the measurement [CORRECT]
C. Using 10 mL of injectate when the system is calibrated for 5 mL
D. The catheter tip positioned in zone 1 of the lung (too proximal)
Correct Answer: B
Rationale: Shivering increases metabolic rate and blood flow, but more importantly, it
creates noise and temperature fluctuations that can interfere with the thermistor
reading. Rapid injection usually gives accurate results; slow injection allows heat
exchange. Incorrect injectate volume affects accuracy but not specifically "falsely low"
predictably. Zone 1 position (above heart level) affects PAOP accuracy, not necessarily
CO measurement.
Q6: You notice the arterial line transducer has been positioned 10 cm below the
patient's right atrium (phlebostatic axis) for the past two hours. How has this affected
the blood pressure readings?
A. The readings have been falsely elevated by approximately 7-8 mmHg [CORRECT]
B. The readings have been falsely lowered by approximately 7-8 mmHg
C. There has been no effect because arterial pressure is independent of transducer
height
D. The systolic pressure reads high but diastolic reads low
Correct Answer: A
Advanced Care of Adults in Acute Settings I | Questions and
Verified Answers | Pass Guaranteed - A+ Graded
Reading Hemodynamic Signals & Waveforms (Hemodynamic Monitoring Principles)
Q1: You're looking at an arterial waveform that seems exaggerated with a systolic peak
higher than expected and a beat-to-beat variation that looks almost jittery. The dicrotic
notch appears absent. When you perform the square wave test, you see a large
overshoot followed by oscillation before settling. This suggests:
A. The system is properly damped and ready for accurate measurement
B. The transducer is positioned too high relative to the patient's phlebostatic axis
C. The system is underdamped, leading to falsely elevated systolic readings [CORRECT]
D. The catheter is kinked or occluded, causing an overdamped waveform
Correct Answer: C
Rationale: An underdamped system oscillates excessively, showing overshoot in the
square wave test and falsely elevated systolic pressures while diastolic may read low.
The dicrotic notch often disappears or looks exaggerated. You'd need to flush the
system or remove air bubbles. A kinked catheter would show a slurred upstroke and
loss of detail (overdamped), not oscillation.
,Q2: A properly zeroed central venous pressure (CVP) catheter measures right atrial
pressure. In a healthy adult without mechanical ventilation or cardiac disease, you'd
expect this value to fall within which range?
A. 0-2 mmHg
B. 2-6 mmHg [CORRECT]
C. 8-12 mmHg
D. 15-20 mmHg
Correct Answer: B
Rationale: Normal CVP is 2-6 mmHg (or 2-8 in some texts). Values below 2 suggest
hypovolemia, while values above 6-8 may indicate volume overload or right heart
dysfunction. 8-12 is the normal range for PAOP (wedge pressure), and 15-20 would
indicate significant right heart failure or volume overload.
Q3: You've floated a pulmonary artery catheter and obtained a pulmonary artery
occlusion pressure (PAOP) reading of 24 mmHg in a patient with acute myocardial
infarction. The patient has crackles bilaterally and is dyspneic. Knowing that PAOP
reflects left ventricular end-diastolic pressure in the absence of mitral valve disease,
what does this reading suggest?
A. The patient is severely volume depleted and needs aggressive fluid resuscitation
B. There is likely left ventricular dysfunction with elevated filling pressures [CORRECT]
C. The catheter is in the wedged position and should be advanced further
D. This is a normal finding immediately following myocardial infarction
,Correct Answer: B
Rationale: A PAOP >18 mmHg (some say >15) suggests elevated left ventricular filling
pressures consistent with cardiogenic pulmonary edema. In this scenario with crackles
and dyspnea, the elevated PAOP indicates LV failure. You would not give fluids; you
might need diuresis or afterload reduction. The catheter is properly wedged to obtain
this reading.
Q4: Your patient has a continuous mixed venous oxygen saturation (SvO2) monitoring
via pulmonary artery catheter. Over the past hour, the SvO2 has dropped from 72% to
55% despite stable arterial oxygen saturation. Which scenario best explains this
desaturation?
A. The patient is receiving too much supplemental oxygen
B. Either oxygen delivery has decreased or oxygen consumption has increased
[CORRECT]
C. The patient has developed a right-to-left intracardiac shunt
D. This represents a calibration error of the catheter
Correct Answer: B
Rationale: SvO2 reflects the balance between oxygen delivery (DO2) and oxygen
consumption (VO2). A drop indicates either decreased delivery (low cardiac output,
anemia, hypoxemia) or increased consumption (sepsis, shivering, agitation). A
right-to-left shunt would lower arterial saturation, not specifically venous. While
calibration errors occur, clinical correlation is needed.
Q5: When measuring cardiac output using the thermodilution method via PAC, which
factor would most likely result in a falsely low cardiac output reading?
, A. Injecting the room-temperature saline too rapidly through the proximal port
B. Patient shivering during the measurement [CORRECT]
C. Using 10 mL of injectate when the system is calibrated for 5 mL
D. The catheter tip positioned in zone 1 of the lung (too proximal)
Correct Answer: B
Rationale: Shivering increases metabolic rate and blood flow, but more importantly, it
creates noise and temperature fluctuations that can interfere with the thermistor
reading. Rapid injection usually gives accurate results; slow injection allows heat
exchange. Incorrect injectate volume affects accuracy but not specifically "falsely low"
predictably. Zone 1 position (above heart level) affects PAOP accuracy, not necessarily
CO measurement.
Q6: You notice the arterial line transducer has been positioned 10 cm below the
patient's right atrium (phlebostatic axis) for the past two hours. How has this affected
the blood pressure readings?
A. The readings have been falsely elevated by approximately 7-8 mmHg [CORRECT]
B. The readings have been falsely lowered by approximately 7-8 mmHg
C. There has been no effect because arterial pressure is independent of transducer
height
D. The systolic pressure reads high but diastolic reads low
Correct Answer: A
