Acute Care Nurse Practitioner Hemodynamic Monitoring and Management 2 — Questions and Answers
Question 1: Which formula correctly calculates systemic vascular resistance (SVR)?
- (MAP - CVP) / CO × 80 (Correct answer)
- (MAP - PAOP) / CO × 80
- (SBP - DBP) / HR × 80
- (CO × HR) / MAP × 80
Correct answer: (MAP - CVP) / CO × 80
SVR = (MAP − CVP) / CO × 80, representing the resistance the left ventricle must overcome to eject blood.
Question 2: A patient with septic shock has a persistently low MAP despite 3L of IV fluids. Which vasopressor is the first-line agent per Surviving Sepsis Campaign guidelines?
- Dopamine
- Epinephrine
- Norepinephrine (Correct answer)
- Phenylephrine
Correct answer: Norepinephrine
Norepinephrine is the first-line vasopressor for septic shock due to its potent alpha-adrenergic effects and favorable safety profile.
Question 3: Which measurement is MOST useful for assessing fluid responsiveness in a mechanically ventilated patient?
- Static CVP
- Pulse pressure variation (PPV) (Correct answer)
- PAOP
- Serum lactate
Correct answer: Pulse pressure variation (PPV)
PPV >13% during mechanical ventilation reliably predicts fluid responsiveness by reflecting preload dependency.
Question 4: A patient has a cardiac output of 3.0 L/min and a body surface area of 2.0 m². What is the cardiac index?
- 1.0 L/min/m²
- 1.5 L/min/m² (Correct answer)
- 3.0 L/min/m²
- 6.0 L/min/m²
Correct answer: 1.5 L/min/m²
Cardiac index = CO / BSA = 3.0 / 2.0 = 1.5 L/min/m², which is below the normal range of 2.2–4.0.
Question 5: An ACNP notes that a patient's arterial line shows a dampened waveform. Which action should be taken FIRST?
- Flush the line with heparin
- Check for air bubbles or kinks in the tubing (Correct answer)
- Reposition the transducer
- Order a stat echocardiogram
Correct answer: Check for air bubbles or kinks in the tubing
A dampened arterial line waveform most commonly results from air bubbles, clots, or kinks in the tubing, which should be assessed first.
Question 6: Which hemodynamic profile is consistent with hypovolemic shock?
- Low CVP, high CO, low SVR
- High CVP, low CO, high SVR
- Low CVP, low CO, high SVR (Correct answer)
- High CVP, high CO, low SVR
Correct answer: Low CVP, low CO, high SVR
Hypovolemic shock presents with low filling pressures (low CVP), low cardiac output, and compensatory high SVR.
Acute Care Nurse Practitioner Hemodynamic Monitoring and Management 2
Which formula correctly calculates systemic vascular resistance (SVR)?