Chapter 07 High Acuity Nursing 6th Edition by Kathleen Dorman Wagner

Chapter 07 High Acuity Nursing 6th Edition by Kathleen Dorman Wagner

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

Question 1

Type: MCSA

The nurse is preparing to use a patient’s pulmonary artery catheter to obtain hemodynamic measurements. Which nursing action is indicated?

1. Zero the transducer at the phlebostatic axis.
2. Place the patient in Trendelenburg position.
3. Warm cardiac output injectate fluid to body temperature.
4. Prepare 20 mL of injectate.

Correct Answer: 1

Rationale 1: The phlebostatic axis approximates the level of the right atrium and is considered to represent the level of the catheter tip.

Rationale 2: Trendelenburg position or the head down position may be used during insertion of the catheter to make visualization of the jugular approach easier. However, supine is the recommended position for hemodynamic readings.

Rationale 3: Injectate should be iced or room temperature but not warmed.

Rationale 4: The traditional method of thermodilution cardiac output uses a 10mL bolus of injectate.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-4

 

Question 2

Type: MCSA

The preceptor nurse is assisting a newly hired nurse with completion of hemodynamic assessment using a pulmonary artery catheter. Which action would require the preceptor to intervene?

1. Inflating the pressure bag to 300 mm Hg
2. Infusing a vasoactive drug through the proximal injectate port
3. Obtaining a pulmonary artery wedge pressure reading through the distal port
4. Using iced normal saline to obtain a cardiac output

Correct Answer: 2

Rationale 1: In order to overcome arterial pressure and prevent blood from backing up into the pressure tubing, the pressure bag placed around the flush solution should be inflated to 300 mm Hg.

Rationale 2: The proximal injectate port is the primary port used for obtaining cardiac output via boluses of iced or room temperature normal saline. Because of the risk of inadvertent bolus of potent medications, neither vasopressor nor vasodilators should be administered through the same port used for obtaining cardiac output. It would be safer to infuse vasoactive drugs through the proximal infusion port.

Rationale 3: The distal port is the designated port for continuous monitoring of the pulmonary artery pressure and for obtaining the pulmonary artery wedge pressure.

Rationale 4: Either iced or room temperature normal saline can effectively be used to obtain accurate cardiac output measurements.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 7-3

 

Question 3

Type: MCSA

While caring for a patient being hemodynamically monitored the nurse notices that the systemic vascular resistance has risen to 1,800 dynes/sec/cm⁵, whereas the patient’s cardiac output remains at 6.0 liters per minute. What would the nurse expect the patient’s blood pressure to be?

1. Increased
2. Unchanged
3. Decreased
4. Initially decreased, and then increased

Correct Answer: 1

Rationale 1: Systemic vascular resistance or afterload is the pressure the heart pumps against to get volume out to the lungs or the body. If that pressure is increased, but volume, measured by cardiac output stays the same, it means that the heart is working harder to get volume out and the blood pressure will go up.

Rationale 2: Increasing systemic vascular resistance with no change in cardiac output does indicate a change in blood pressure.

Rationale 3: Since the heart is working harder, blood pressure will not decrease immediately.

Rationale 4: The blood pressure would increase initially in response to the increased workload. If treatment is not initiated, the heart will eventually tire, and a decrease in blood pressure could be expected.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 7-7

 

Question 4

Type: MCSA

The nurse is reviewing the results of a patient’s cardiac output curve and notes that the size of the curve is small. Which of the following does this finding indicate?

1. A low cardiac output
2. Poor injection technique
3. Incorrect placement of the catheter
4. A high cardiac output

Correct Answer: 4

Rationale 1: A large curve indicates a slow return to baseline temperature and, therefore, a low cardiac output.

Rationale 2: The size of the curve does not indicate poor injection technique.

Rationale 3: A small cardiac output curve does not indicate incorrect placement of the catheter.

Rationale 4: A small curve indicates a rapid return of the blood to its baseline temperature and, therefore, a high cardiac output.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 7-3