Clinical Findings
What are the beneficial hemodynamic effects of intra-aortic balloon
(IAB) therapy?
It increases the myocardial oxygen supply during diastole.
(Question 1)
Which hemodynamic change will result in an increase in the cardiac output?
A. an increase in the afterload B. a decrease in contractility C. an increase in the heart rate D. a decrease in the preload
C. an increase in the heart rate
(Question 15)
The patient is receiving fluid resuscitation and a norepinephrine (Levophed) drip for the treatment of septic shock. What are the beneficial effects of these treatments on the patient's hemodynamics?
The fluids are increasing the preload, and the norepinephrine is increasing the afterload.
(Question 10)
RA 1 mmHg; PAOP 5 mmHg; SVR 1,550 dynes/sec/cm-5; Cl 2.2 L/min/m2 shock
A. Cardiogenic B. Hypovolemic C. Septic shock
D. Right ventricular failure
B. Hypovolemic
The patient with diastolic heart failure develops supraventricular tachycardia, heart rate 220/min. The most dangerous hemodynamic effect is a decrease in:
A) Myocardial contractility
B) Coronary Artery perfusion
C) Ejection fraction
D) Arterial oxygenation
B) Coronary Artery perfusion
What hemodynamic findings would be expected for a patient with left heart failure with a blood pressure of 128/68?
PAOP 20 mmHg
(Question 6)
The patient was admitted with a gunshot wound to the abdomen and has hemorrhagic shock. Which of the following hemodynamic profiles would reflect a patient in this situation?
A. PAOP 10 mmHg; SVR 1,100 dynes/sec/cm-5; CO 5 L/minute B. PAOP 3 mmHg; SVR 1,500 dynes/sec/cm-5; CO 2.5 L/minute C. PAOP 18 mmHg; SVR 1,100 dynes/sec/cm-5; CO 4 L/minute D. PAOP 4 mmHg; SVR 700 dynes/sec/cm-5; CO 3 L/minute
B. PAOP 3 mmHg; SVR 1,500 dynes/sec/cm-5; CO 2.5 L/minute
(Question 9)
The patient with septic shock is receiving ongoing fluid resuscitation and a norepinephrine drip. Which of the following parameters indicates that the fluid resuscitation target has been achieved?
A. ScO, of 0.72 B. lactate of 7 mmol/L C. SvO2 of 0.82 D. CVP of 1 mmHg
A. ScO, of 0.72
(Question 13)
RA 6 mmHg; PAOP 22 mmHg; SVR 1,750 dynes/sec/cm-5; CI 1.8 L/min/m2
A. Cardiogenic B. Hypovolemic C. Septic shock
D. Right ventricular failure
A. Cardiogenic
Which of the following clinical findings would you expect to find in the patient with septic shock?
A) SIRS, electrolyte imbalance
B) Infection, fever
C) Lactate 8, Sv02 85
D) Positive blood culture, SIRS
C) Lactate 8, Sv02 85
Elevated lactate is evidence of anaerobic metabolism and elevated SvO2 is evidence of decreased oxygen utilization at the cellular level—both definitive for septic shock. The remaining choices may be seen in earlier phases of the infection continuum (sepsis or severe sepsis) or not typical of any infectious process.
The patient has a sustained Sv0, of 0.55. Which clinical abnormality may be the cause of this SvO2?
A. hypothermia B. a cardiac index of 5 L/min/m2 C. hypoxemia D. therapeutic paralvsis
C. hypoxemia
(Question 7)
The patient with an acute inferior MI and a pulmonary artery (PA)
catheter develops acute respiratory distress and a loud systolic murmur at the apex of the heart. The nurse suspects that the clinical change in the patient's condition is due to acute mitral valve regurgitation. What hemodynamic findings would support a clinical change in the patient's condition is due to acute mitral valve regurgitation?
The PAOP increases.
(Question 5)
The patient is admitted with acute chest pain and an acute inferior
MI. The patient's blood pressure is 78/54, and the following pressure readings were obtained from the pulmonary artery (PA) catheter:
RAP: 15 mmHg PAP: 19/4 mmHg PAOP: 5 mmHg CI: 1.9 L/min/m2 SVR: 1,650 dynes/sec/cm-5
Based on these values, what is the initial treatment indicated for this patient?
fluids
(Question 4)
RA 2 mmHg; PAOP 9 mmHg; SVR 550 dynes/sec/cm-5; CI 8.5 L/min/m2
A. Cardiogenic B. Hypovolemic C. Septic shock
D. Right ventricular failure
C. Septic shock
One hemodynamic benefit of intra-aortic balloon therapy is:
A) Balloon inflation prevents right to left shunt
B) Balloon deflation increases coronary artery perfusion
C) Balloon inflation optimizes aortic valve performance
D) Balloon deflation decreases left ventricular afterload
D) Balloon deflation decreases left ventricular afterload
The patient has an SVR of 520 dynes/sec/cm-5. This finding would typically be seen in the event of which of the following problems?
A. septic shock and anaphylactic shock B. cardiogenic shock and left ventricular failure C. cardiac tamponade and pulmonary hypertension D. hypovolemic shock and COPD
A. septic shock and anaphylactic shock
(Question 11)
Which of the following hemodynamic profiles is typical of a patient with cardiac tamponade?
A. RAP 1 mmHg; PAP 21/10 mmg; PAOP 12 mmHg;
CO 4.0 L/min B. RAP 3 mmHg; PAP 26/9 mmHg; PAOP 10 mmHg; CO 5.0 L/min C. RAP 14 mmHg; PAP 30/15 mHg; PAOP 14 mmHg; CO 2.0 L/min D. RAP 10 mmHg; PAP 30/15 mmHg; PAOP 8 mmHg;
CO 3.0 L/min
C. RAP 14 mmHg; PAP 30/15 mHg; PAOP 14 mmHg;
CO 2.0 L/min
(Question 12)
Two days after admission with an anterior MI, a patient complains of chest pain. Respirations are 26 breaths/minute and labored. Additional findings include cool and clammy skin, a gallop rhythm, crackles halfway up on both lung fields, and a clouding sensorium. Clinical data include:
BP: 78/50 PAOP: 30 mmHg CO: 2.9 L/min
CI: 1.4 L/min/m2 SVR: 1,600 dynes/sec/cm-5
The nurse should expect the patient's immediate treatment to include which of the following?
vasodilators and positive inotropic agents
(Question 3)
RA 14 mmHg; PAOP 4 mmHg; SVR 1,450 dynes/sec/cm-5; CI 2.0 L/min/m2 shock
A. Cardiogenic B. Hypovolemic C. Septic shock
D. Right ventricular failure
D. Right ventricular failure
The patient with right ventricular infarction would most likely have which of the following hemodynamic pressure findings?
A) Right atrial (RA) 4 mmHg, pulmonary artery occlusive pressure (PAOP) 18 mmHg
B) Right atrial (RA) 14 mmHg, pulmonary artery occlusive pressure (PAOP) 5 mmHg
C) Right atrial (RA) 14 mmHg, pulmonary artery occlusive pressure (PAOP) 18 mmHg
D) Right atrial (RA) 0 mmHg, pulmonary artery occlusive pressure (PAOP) 5 mmHg
B) Right atrial (RA) 14 mmHg, pulmonary artery occlusive pressure (PAOP) 5 mmHg
What clinical and hemodynamic findings are expected if the patient has hypotension with acute inferior STEM and a right ventricular infarction?
an elevated RA pressure and distended neck veins
(Question 8)
Cardiogenic shock secondary to left ventricular failure will generally result in:
A) Decreased afterload
B) Narrow Pulse Pressure
C) Decreased Preload
D) Widening Pulse Pressure
B) Narrow Pulse Pressure
The nurse performs a dynamic response test for a patient with an arterial line. The nurse notes that the waveform is overdamped.
Which intervention is appropriate to address this issue?
A. Remove the add-on tubing. B. Assess for kinking of the catheter/ tubing system. C. Flush the line to remove pinpoint air bubbles. D. Compare a cuff pressure with the arterial line pressure going forward.
B. Assess for kinking of the catheter/ tubing system.
(Question 2)
Which of the following hemodynamic profiles would benefit from aggressive fluid administration, pressors and antibiotic therapy?
A) RAP 1, PAOP 4, SVR 1800, CO 2 L/min
B) RAP 5, PAOP 7, SVR 400, CO 8 L/min
C) RAP 5, PAOP 17, SVR 1900, CO 2 L/min
D) RAP 12, PAOP 7, SVR 1400, CO 5 L/min
B) RAP 5, PAOP 7, SVR 400, CO 8 L/min
The patient presents with hypotension refractory to initial treatment and a pulmonary artery catheter was placed. The hemodynamic profile demonstrated right atrial (RA) pressure 0 mmHg, pulmonary artery pressure (PAP) 19/6 mmHg, pulmonary artery occlusive pressure (PAOP) 4 mmHg, systemic vascular resistance (SVR) 400 dynes/sec/cm5, and SvO2 80%. What is most likely the cause of the patient's hypotension, and what is the treatment?
A) Hypovolemic shock; fluids B) Septic Shock; vasopressors C) Cardiogenic shock; IABP D) Anaphylactic shock; epinephrine IM
B) Septic shock; vasopressors