Term
| Which hemodynamic parameter is most appropriate for the nurse to monitor to determine the effectiveness of medications given to a patient to reduce left ventricular afterload? |
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Definition
| Systemic vascular resistance reflects the resistance to ventricular ejection, or afterload |
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Term
| Following surgery for an abdominal aortic aneurysm, a patient’s central venous pressure (CVP) monitor indicates low pressures. Which action is a priority for the nurse to take? |
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Definition
| Increase the IV fluid infusion - A low CVP indicates hypovolemia and a need for an increase in the infusion rate |
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Term
| When caring for a patient with pulmonary hypertension, which parameter is most appropriate for the nurse to monitor to evaluate the effectiveness of the treatment? |
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Definition
| Pulmonary vascular resistance (PVR) is a major contributor to pulmonary hypertension, and a decrease would indicate that pulmonary hypertension was improving. |
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Term
| The intensive care unit (ICU) nurse educator will determine that teaching about arterial pressure monitoring for a new staff nurse has been effective when the nurse |
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Definition
| positions the zero-reference stopcock line level with the phlebostatic axis |
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Term
| When monitoring for the effectiveness of treatment for a patient with a large anterior wall myocardial infarction, the most important information for the nurse to obtain is |
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Definition
| PAWP reflects left ventricular end diastolic pressure (or left ventricular preload) and is a sensitive indicator of cardiac function. Because the patient is high risk for left ventricular failure, the PAWP must be monitored. An increase will indicate left ventricular failure |
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Term
| Which action is a priority for the nurse to take when the low pressure alarm sounds for a patient who has an arterial line in the left radial artery? |
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Definition
| Assess for cardiac dysrhythmias - The low pressure alarm indicates a drop in the patient’s blood pressure, which may be caused by cardiac dysrhythmias. |
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Term
| Which action will the nurse need to do when preparing to assist with the insertion of a pulmonary artery catheter? |
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Definition
| Attach cardiac monitoring leads before the procedure. |
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Term
| When assisting with the placement of a pulmonary artery (PA) catheter, the nurse notes that the catheter is correctly placed when the monitor shows a |
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Definition
| typical PA wedge pressure (PAWP) tracing. The purpose of a PA line is to measure PAWP, so the catheter is floated through the pulmonary artery until the dilated balloon wedges in a distal branch of the pulmonary artery, and the PAWP readings are available. After insertion, the balloon is deflated and the PA waveform will be observed. |
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Term
| The central venous oxygen saturation (ScvO2) is decreasing in a patient who has severe pancreatitis. To determine the possible cause of the decreased ScvO2, the nurse assesses the patient’s |
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Definition
| temperature. Elevated temperature increases metabolic demands and oxygen use by tissues, resulting in a drop in oxygen saturation of central venous blood |
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Term
| An intraaortic balloon pump (IABP) is being used for a patient who is in cardiogenic shock. Which assessment data indicate to the nurse that the goals of treatment with the IABP are being met? |
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Definition
| Cardiac output (CO) of 5 L/min. A CO of 5 L/min is normal and indicates that the IABP has been successful in treating the shock. |
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Term
| The nurse is caring for a patient who has an intraaortic balloon pump in place. Which action should be included in the plan of care? |
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Definition
| Measure the patient’s urinary output every hour. Monitoring urine output will help determine whether the patient’s cardiac output has improved and also help monitor for balloon displacement |
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Term
| While waiting for cardiac transplantation, a patient with severe cardiomyopathy has a ventricular assist device (VAD) implanted. When planning care for this patient, the nurse should anticipate |
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Definition
| monitoring the surgical incision for signs of infection. The insertion site for the VAD provides a source for transmission of infection to the circulatory system and requires frequent monitoring. |
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Term
| To verify the correct placement of an oral endotracheal tube (ET) after insertion, the best initial action by the nurse is to |
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Definition
| use an end-tidal CO2 monitor to check for placement in the trachea. End-tidal CO2 monitors are currently recommended for rapid verification of ET placement. |
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Term
| To maintain proper cuff pressure of an endotracheal tube (ET) when the patient is on mechanical ventilation, the nurse should |
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Definition
| inject air into the cuff until a slight leak is heard only at peak inflation |
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Term
| The nurse notes premature ventricular contractions (PVCs) while suctioning a patient’s endotracheal tube. Which action by the nurse is a priority? |
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Definition
| Stop and ventilate the patient with 100% oxygen. Dysrhythmias during suctioning may indicate hypoxemia or sympathetic nervous system stimulation. The nurse should stop suctioning and ventilate the patient with 100% oxygen. |
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Term
| Which assessment finding obtained by the nurse when caring for a patient receiving mechanical ventilation indicates the need for suctioning? |
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Definition
| The patient’s respiratory rate is 32 breaths/minute. |
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Term
| The nurse notes thick, white secretions in the endotracheal tube (ET) of a patient who is receiving mechanical ventilation. Which intervention will be most effective in addressing this problem? |
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Definition
| Add additional water to the patient’s enteral feedings |
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Term
| Four hours after mechanical ventilation is initiated for a patient with chronic obstructive pulmonary disease (COPD), the patient’s arterial blood gas (ABG) results include a pH of 7.51, PaO2 of 82 mm Hg, PaCO2 of 26 mm Hg, and HCO3– of 23 mEq/L (23 mmol/L). The nurse will anticipate the need to |
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Definition
| decrease the respiratory rate. The patient’s PaCO2 and pH indicate respiratory alkalosis caused by too high a respiratory rate. The PaO2 is appropriate for a patient with COPD and increasing the respiratory rate and tidal volume would further lower the PaCO2. |
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Term
| A patient with respiratory failure has arterial pressure–based cardiac output (APCO) monitoring and is receiving mechanical ventilation with peak end-expiratory pressure (PEEP) of 12 cm H2O. Which information indicates that a change in the ventilator settings may be required? |
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Definition
| The arterial pressure is 90/46. The hypotension suggests that the high intrathoracic pressure caused by the PEEP may be decreasing venous return and (potentially) cardiac output. |
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Term
| A nurse is weaning a 68-kg male patient who has chronic obstructive pulmonary disease (COPD) from mechanical ventilation. Which patient assessment finding indicates that the weaning protocol should be stopped? |
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Definition
| The patient respiratory rate is 32 breaths/min. Tachypnea is a sign that the patient’s work of breathing is too high to allow weaning to proceed. The patient’s heart rate is within normal limits, although the nurse should continue to monitor it. An oxygen saturation of 93% is acceptable for a patient with COPD. A spontaneous tidal volume of 450 mL is within the acceptable range. |
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Term
| The nurse is caring for a patient receiving a continuous norepinephrine (Levophed) IV infusion. Which patient assessment finding indicates that the infusion rate may need to be adjusted? |
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Definition
| Systemic vascular resistance (SVR) is elevated Vasoconstrictors such as norepinephrine (Levophed) will increase SVR, and this will increase the work of the heart and decrease peripheral perfusion. The infusion rate may need to be decreased. Bradycardia, hypotension (MAP of 56 mm Hg), and low PAWP are not associated with norepinephrine infusion. |
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Term
| When caring for the patient with a pulmonary artery (PA) pressure catheter, the nurse observes that the PA waveform indicates that the catheter is in the wedged position. Which action should the nurse take next? |
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Definition
| Deflate and reinflate the PA balloon. When the catheter is in the wedge position, blood flow past the catheter is obstructed, placing the patient at risk for pulmonary infarction. A health care provider or advanced practice nurse should be called to reposition the catheter |
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Term
| When evaluating a patient with a central venous catheter, the nurse observes that the insertion site is red and tender to touch and the patient’s temperature is 101.8° F. What should the nurse plan to do next |
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Definition
| Discontinue the catheter and culture the tip. The information indicates that the patient has a local and systemic infection caused by the catheter, and the catheter should be discontinued. |
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Term
| When caring for a patient who has an arterial catheter in the left radial artery for arterial pressure–based cardiac output (APCO) monitoring, which information obtained by the nurse is most important to report to the health care provider? |
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Definition
| There is redness at the catheter insertion site - indicates possible infection |
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Term
| The nurse responds to a ventilator alarm and finds the patient lying in bed holding the endotracheal tube (ET). Which action should the nurse take next? |
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Definition
| d. Manually ventilate the patient with 100% oxygen. |
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Term
| The nurse notes that a patient’s endotracheal tube (ET), which was at the 22-cm mark, is now at the 25-cm mark and the patient is anxious and restless. Which action should the nurse take next? |
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Definition
| Listen to the patient’s breath sounds. The nurse should first determine whether the ET tube has been displaced into the right mainstem bronchus by listening for unilateral breath sounds. If so, assistance will be needed to reposition the tube immediately |
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Term
| The nurse educator is evaluating the care that a new registered nurse (RN) provides to a patient receiving mechanical ventilation. Which action by the new RN indicates the need for more education? |
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Definition
| The RN positions the patient with the head of bed at 10 degrees. The head of the patient’s bed should be positioned at 30 to 45 degrees to prevent ventilator-associated pneumonia |
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Term
| A patient who is orally intubated and receiving mechanical ventilation is anxious and is “fighting” the ventilator. Which action should the nurse take next? |
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Definition
| Verbally coach the patient to breathe with the ventilator. |
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Term
| The nurse educator is evaluating the performance of a new registered nurse (RN) who is providing care to a patient who is receiving mechanical ventilation with 15 cm H2O of peak end-expiratory pressure (PEEP). Which action indicates that the new RN is safe? |
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Definition
| The RN uses a closed-suction technique to suction the patient. The closed-suction technique is used when patients require high levels of PEEP (>10 cm H2O) to prevent the loss of PEEP that occurs when disconnecting the patient from the ventilator. |
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Term
| The nurse is caring for a patient with a subarachnoid hemorrhage who is intubated and placed on a mechanical ventilator with 10 cm H2O of peak end-expiratory pressure (PEEP). When monitoring the patient, the nurse will need to notify the health care provider immediately if the patient develops |
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Definition
| increased jugular venous distention. Increases in jugular venous distention in a patient with a subarachnoid hemorrhage may indicate an increase in intracranial pressure (ICP) and that the PEEP setting is too high for this patient. |
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Term
| A patient who is receiving positive pressure ventilation is scheduled for a spontaneous breathing trial (SBT). Which finding by the nurse is most important to discuss with the health care provider before starting the SBT? |
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Definition
| New ST segment elevation is noted on the cardiac monitor. Myocardial ischemia is a contraindication for ventilator weaning. The ST segment elevation is an indication that weaning should be postponed until further investigation and/or treatment for myocardial ischemia can be done. |
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Term
| After change-of-shift report on a ventilator weaning unit, which patient should the nurse assess first? |
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Definition
| Patient who was successfully weaned and extubated 4 hours ago and now has no urine output for the last 6 hours. The decreased urine output may indicate acute kidney injury or that the patient’s cardiac output and perfusion of vital organs have decreased |
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Term
| After change-of-shift report, which patient should the progressive care nurse assess first? |
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Definition
| Patient who is receiving IV heparin for a venous thromboembolism and has a partial thromboplastin time (PTT) of 98 sec |
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