CCRN - Review Hemodynamic Monitoring Questions and Answers 1

Question 1

A patient in the ICU develops hypotension, tachycardia, and a decreased cardiac output. The pulmonary artery catheter reveals the following readings: CVP 1 mmHg, PAWP 4 mmHg, and SVR 1800 dynes/sec/cm-5. Which of the following conditions is the MOST likely cause of this hemodynamic profile?

Accepted Answer

Hypovolemic shock

Answer

The hemodynamic profile of low CVP (preload), low PAWP (left ventricular preload), and high SVR (afterload) with a low cardiac output is characteristic of hypovolemic shock. The body compensates for the loss of volume by constricting blood vessels, which increases SVR, in an attempt to maintain blood pressure.

Question 2

A critical care nurse is performing a square wave test on an arterial line. The resulting waveform shows a rapid upstroke and downstroke, followed by two oscillations before returning to the arterial waveform. This finding indicates:

Accepted Answer

A properly functioning system

Answer

A properly functioning arterial line system will produce 1-2 oscillations after the fast-flush square wave test. This indicates that the system is appropriately damped and providing accurate pressure readings. More than two oscillations would suggest an underdamped system, while fewer than 1.5 would indicate an overdamped system.

Question 3

A patient is admitted with decompensated right-sided heart failure. Which set of hemodynamic parameters would the nurse most expect to find?

Accepted Answer

High CVP, low PAWP, normal to high PVR

Answer

In right-sided heart failure, the right ventricle fails to pump effectively, leading to a backup of blood in the systemic venous circulation. This results in an elevated Central Venous Pressure (CVP). The Pulmonary Artery Wedge Pressure (PAWP), which reflects left-sided preload, would be low or normal unless there is concurrent left-sided failure. Pulmonary Vascular Resistance (PVR) may be elevated, as it is a common cause of right heart failure.

Question 4

The dicrotic notch on an arterial pressure waveform represents:

Accepted Answer

The closure of the aortic valve

Answer

The dicrotic notch is a small, downward deflection on the arterial waveform that follows the systolic peak. It signifies the closure of the aortic valve and the beginning of diastole. This closure causes a brief retrograde flow of blood, which creates the notch.

Question 5

A patient with septic shock has a low Systemic Vascular Resistance (SVR). Which of the following medications would be most appropriate to administer to address this specific hemodynamic alteration?

Accepted Answer

Norepinephrine

Answer

Septic shock is a type of distributive shock characterized by massive vasodilation, leading to a decreased SVR. Norepinephrine is a potent vasopressor that causes peripheral vasoconstriction, thereby increasing SVR and helping to restore blood pressure. Dobutamine is an inotrope, Nitroglycerin is a vasodilator, and Furosemide is a diuretic.

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CCRN - Review Hemodynamic Monitoring Questions and Answers 1