CCRN Hemodynamic Monitoring 3 — Questions and Answers
Question 1: A square wave (fast-flush) test shows excessive oscillations before returning to baseline. This indicates:
- An underdamped system (Correct answer)
- An overdamped system
- An optimally damped system
- Transducer failure
Correct answer: An underdamped system
Multiple oscillations after the flush indicate underdamping, which overestimates systolic pressure.
Question 2: Which formula correctly expresses mean arterial pressure (MAP)?
- (SBP + 2 x DBP) / 3 (Correct answer)
- (2 x SBP + DBP) / 3
- (SBP + DBP) / 2
- SBP - DBP
Correct answer: (SBP + 2 x DBP) / 3
MAP weights diastole more heavily because diastole occupies more of the cardiac cycle.
Question 3: A high CVP with hypotension, jugular venous distension, and muffled heart sounds suggests:
- Cardiac tamponade (Correct answer)
- Hypovolemic shock
- Septic shock
- Anaphylaxis
Correct answer: Cardiac tamponade
Beck's triad of elevated venous pressure, hypotension, and muffled heart sounds defines tamponade.
Question 4: Stroke volume variation (SVV) is a useful predictor of fluid responsiveness primarily in patients who are:
- Mechanically ventilated in sinus rhythm (Correct answer)
- Spontaneously breathing
- In atrial fibrillation
- Receiving high-dose vasopressors
Correct answer: Mechanically ventilated in sinus rhythm
SVV reliability depends on positive-pressure ventilation and regular cardiac rhythm.
Question 5: Cardiac index is calculated by dividing cardiac output by:
- Body surface area (Correct answer)
- Body weight
- Heart rate
- Mean arterial pressure
Correct answer: Body surface area
Cardiac index normalizes cardiac output to body surface area for comparison across patients.
Question 6: An elevated systemic vascular resistance (SVR) with low cardiac output is most consistent with:
- Cardiogenic shock (Correct answer)
- Septic shock
- Neurogenic shock
- Anaphylactic shock
Correct answer: Cardiogenic shock
Compensatory vasoconstriction raises SVR while a failing heart lowers output in cardiogenic shock.
Question 7: During PA catheter insertion, a sustained right ventricular waveform indicates the tip is in the RV and the nurse should:
- Notify the provider to advance or withdraw to reduce arrhythmia risk (Correct answer)
- Inflate the balloon and leave it
- Flush vigorously and continue monitoring
- Document and take no action
Correct answer: Notify the provider to advance or withdraw to reduce arrhythmia risk
A catheter tip lodged in the RV can provoke ventricular arrhythmias and must be repositioned.
CCRN Hemodynamic Monitoring 3
A square wave (fast-flush) test shows excessive oscillations before returning to baseline.
This indicates: