Cardiac Output & Perfusion
A patient’s blood pressure is 86/48 mm Hg, heart rate 118/min, and urine output has decreased. Which change would most directly improve cardiac output?
A. Increasing preload
B. Decreasing afterload
C. Increasing airway resistance
A. Increasing preload
A nurse notes dampened arterial waveforms and falsely low systolic readings. What is the most likely cause?
A. Air bubbles or clots in the tubing
B. Excessive arterial pressure
C. Incorrect blood pressure cuff size
A. Air bubbles or clots in the tubing
A patient’s ABG shows: pH 7.30, PaCO₂ 55 mm Hg, PaO₂ 78 mm Hg. How should the nurse interpret this?
A. Respiratory alkalosis
B. Respiratory acidosis
C. Metabolic acidosis
B. Respiratory acidosis
A patient with pneumonia becomes increasingly confused and tachypneic. Which action is the nurse’s priority?
A. Obtain a chest x-ray
B. Assess airway and breathing
C. Notify respiratory therapy
B. Assess airway and breathing
Before interpreting invasive pressure readings, the nurse must first ensure which action has been completed?
A. Zeroing the transducer
B. Flushing the line
C. Replacing the tubing
A. Zeroing the transducer
A nurse is evaluating a patient with heart failure. Which finding best indicates decreased tissue perfusion?
A. Oxygen saturation of 95%
B. Serum lactate of 4.2 mmol/L
C. CVP of 6 mm Hg
B. Serum lactate of 4.2 mmol/L
When leveling an arterial line transducer, the nurse places it at which location?
A. Fifth intercostal space, midclavicular line
B. Fourth intercostal space, midaxillary line
C. Sternal notch
B. Fourth intercostal space, midaxillary line
Which finding indicates increased work of breathing?
A. Slow respiratory rate
B. Use of accessory muscles
C. Decreased PaCO₂
B. Use of accessory muscles
Which finding best differentiates hypoxemic from hypercapnic respiratory failure?
A. Elevated PaCO₂
B. Elevated PaO₂
C. Increased respiratory rate
A. Elevated PaCO₂
A patient has a normal SpO₂ but an elevated lactate level. This suggests:
A. Adequate tissue perfusion
B. Impaired oxygen delivery at the cellular level
C. Improved cardiac output
B. Impaired oxygen delivery at the cellular level
A patient receiving vasopressors develops an increased systemic vascular resistance. Which hemodynamic variable is most affected?
A. Preload
B. Afterload
C. Contractility
B. Afterload
Which complication is the nurse most concerned about when an arterial line is placed in the femoral artery?
A. Pneumothorax
B. Infection
C. Cerebral hypoperfusion
B. Infection
A patient has difficulty exhaling due to airway narrowing. Which ventilatory variable is primarily increased?
A. Compliance
B. Airway resistance
C. Functional residual capacity
B. Airway resistance
Which patient is at greatest risk for developing acute respiratory failure?
A. A postoperative patient receiving opioids
B. A patient with controlled hypertension
C. A young adult with mild asthma
A. A postoperative patient receiving opioids
Which nursing action best reduces infection risk associated with invasive lines?
A. Frequent flushing
B. Daily line necessity review and aseptic technique
C. Increased monitoring frequency
B. Daily line necessity review and aseptic technique
Which assessment finding most strongly suggests a decrease in cardiac output?
A. Bounding peripheral pulses
B. Narrow pulse pressure
C. Warm, flushed skin
B. Narrow pulse pressure
The nurse identifies a flattened arterial waveform. Which intervention is most appropriate?
A. Flush the system and assess tubing
B. Increase IV fluids
C. Lower the transducer
A. Flush the system and assess tubing
Which change would most improve oxygenation in a patient with alveolar collapse?
A. Increasing respiratory rate
B. Increasing PEEP
C. Decreasing FiO₂
B. Increasing PEEP
A patient with ARDS has persistent hypoxemia despite high FiO₂. Which intervention is most effective?
A. Increasing tidal volume
B. Applying PEEP
C. Decreasing ventilator rate
B. Applying PEEP
The nurse performs passive leg raising to evaluate fluid responsiveness. This maneuver simulates which intervention?
A. A 250–500 mL fluid bolus
B. Increased afterload
C. Decreased preload
A. A 250–500 mL fluid bolus
A nurse calculates cardiac index instead of cardiac output because cardiac index:
A. Reflects ventricular preload
B. Accounts for body surface area
C. Measures myocardial oxygen demand
B. Accounts for body surface area
Which nursing assessment is priority for a patient with an arterial line?
A. Neuromuscular status distal to insertion site
B. Daily electrolyte monitoring
C. Intake and output every 8 hours
A. Neuromuscular status distal to insertion site
PaO₂ of 55 mm Hg indicates:
A. Normal oxygenation
B. Life-threatening hypoxemia
C. Mild hypoxia requiring no intervention
B. Life-threatening hypoxemia
Which nursing assessment best evaluates response to oxygen therapy?
A. Respiratory rate
B. SpO₂ trend
C. Lung auscultation alone
B. SpO₂ trend
A patient with respiratory failure becomes acutely confused and tachypneic. Which nursing priority is most appropriate?
A. Obtain ABGs
B. Notify the provider
C. Assess airway and breathing immediately
C. Assess airway and breathing immediately