Acute Care Nurse Practitioner Hemodynamic Monitoring and Management

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?

Accepted Answer

Cardiogenic shock

Answer

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?

Accepted Answer

Pulmonary artery occlusion pressure

Answer

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?

Accepted Answer

Cardiac tamponade

Answer

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?

Accepted Answer

70%

Answer

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?

Accepted Answer

Start dobutamine

Answer

With adequate MAP and high SVR but low urine output suggesting poor perfusion, adding dobutamine addresses low cardiac output and improves organ perfusion.

Acute Care Nurse Practitioner Practice Test

Acute Care Nurse Practitioner Practice Test

Acute Care Nurse Practitioner Hemodynamic Monitoring and Management