Acute Care Nurse Practitioner Hemodynamic Monitoring and Management 1 — Questions and Answers
Question 1: A patient in the ICU has a pulmonary artery occlusion pressure (PAOP) of 22 mmHg and a cardiac index of 1.8 L/min/m². Which condition does this most likely indicate?
- Cardiogenic shock (Correct answer)
- Distributive shock
- Hypovolemic shock
- Obstructive shock
Correct answer: Cardiogenic shock
Elevated PAOP with low cardiac index is the hallmark of cardiogenic shock, indicating pump failure with fluid backup.
Question 2: Which hemodynamic parameter best reflects left ventricular preload?
- Central venous pressure
- Pulmonary artery occlusion pressure (Correct answer)
- Systemic vascular resistance
- Mean arterial pressure
Correct answer: Pulmonary artery occlusion pressure
PAOP (wedge pressure) reflects left atrial pressure and is the best clinical estimate of left ventricular preload.
Question 3: A patient's arterial line waveform shows pulsus paradoxus. Which condition should the ACNP suspect first?
- Aortic stenosis
- Cardiac tamponade (Correct answer)
- Mitral regurgitation
- Pulmonary hypertension
Correct answer: Cardiac tamponade
Pulsus paradoxus (>10 mmHg drop in systolic BP during inspiration) is a classic sign of cardiac tamponade due to pericardial compression.
Question 4: Which ScvO₂ value indicates adequate oxygen delivery relative to consumption in a critically ill patient?
- 45%
- 55%
- 70% (Correct answer)
- 85%
Correct answer: 70%
ScvO₂ ≥70% (or SvO₂ ≥65%) suggests adequate oxygen delivery; values below this indicate tissue hypoperfusion.
Question 5: A patient receiving norepinephrine has an SVR of 1,800 dynes/s/cm⁻⁵ and MAP of 92 mmHg, but urine output is 15 mL/hr. What is the MOST appropriate next step?
- Increase norepinephrine dose
- Add vasopressin
- Give a fluid bolus
- Start dobutamine (Correct answer)
Correct answer: Start dobutamine
With adequate MAP and high SVR but low urine output suggesting poor perfusion, adding dobutamine addresses low cardiac output and improves organ perfusion.
Question 6: When interpreting a CVP waveform, prominent 'v' waves are associated with which condition?
- Tricuspid regurgitation (Correct answer)
- Aortic stenosis
- Cardiac tamponade
- Heart block
Correct answer: Tricuspid regurgitation
Prominent 'v' waves on CVP waveform reflect regurgitant flow back into the right atrium during tricuspid regurgitation.
Acute Care Nurse Practitioner Hemodynamic Monitoring and Management 1
A patient in the ICU has a pulmonary artery occlusion pressure (PAOP) of 22 mmHg and a cardiac index of 1.8 L/min/m².
Which condition does this most likely indicate?