PCU Hemodynamic Monitoring & Vascular Access 1 — Questions and Answers
Question 1: A PCU patient has an arterial line in place. The nurse notes the waveform is dampened. What is the most appropriate first action?
- Flush the line with a rapid manual flush
- Check for air bubbles, kinks, or loose connections in the tubing (Correct answer)
- Reposition the transducer to the phlebostatic axis
- Notify the physician immediately
Correct answer: Check for air bubbles, kinks, or loose connections in the tubing
A dampened arterial waveform is most commonly caused by air bubbles, clots, kinks, or loose connections, which should be assessed and corrected first before other interventions.
Question 2: The phlebostatic axis, used as the reference point for hemodynamic monitoring, is located at the intersection of which anatomical landmarks?
- The midaxillary line and the 2nd intercostal space
- The midaxillary line and the 4th intercostal space (Correct answer)
- The anterior axillary line and the 4th intercostal space
- The posterior axillary line and the 3rd intercostal space
Correct answer: The midaxillary line and the 4th intercostal space
The phlebostatic axis is at the intersection of the midaxillary line and the 4th intercostal space, corresponding to the level of the right atrium.
Question 3: A patient's central venous pressure (CVP) reading is 2 mmHg. Which clinical condition does this finding most likely indicate?
- Fluid overload
- Hypovolemia (Correct answer)
- Right ventricular failure
- Cardiac tamponade
Correct answer: Hypovolemia
A CVP of 2 mmHg is below the normal range of 2–8 mmHg and suggests hypovolemia or decreased venous return.
Question 4: Which of the following is a contraindication to placing a radial arterial line?
- History of hypertension
- Positive Allen's test (Correct answer)
- Need for continuous blood pressure monitoring
- Anticoagulation therapy
Correct answer: Positive Allen's test
A positive Allen's test indicates inadequate collateral circulation from the ulnar artery, making radial arterial line placement unsafe due to risk of hand ischemia.
Question 5: When zeroing an arterial line transducer, the nurse should:
- Close the stopcock to the patient and open it to air (Correct answer)
- Open the stopcock to the patient and close it to air
- Flush the system with normal saline before zeroing
- Place the patient in the Trendelenburg position
Correct answer: Close the stopcock to the patient and open it to air
Zeroing requires closing the stopcock to the patient and opening it to air (atmospheric pressure) so the monitor can calibrate to zero.
Question 6: A PCU nurse is caring for a patient with a central venous catheter (CVC). Which action is essential when changing the CVC dressing?
- Use clean technique with non-sterile gloves
- Apply a transparent, semipermeable membrane dressing using sterile technique (Correct answer)
- Change the dressing every 24 hours regardless of condition
- Cleanse the insertion site with povidone-iodine only
Correct answer: Apply a transparent, semipermeable membrane dressing using sterile technique
CVC dressing changes require sterile technique with a transparent semipermeable membrane dressing to prevent central line-associated bloodstream infections (CLABSI).
Question 7: A patient's mean arterial pressure (MAP) is calculated to be 58 mmHg. How should the nurse interpret this finding?
- Normal; no intervention needed
- Indicative of hypertensive urgency
- Inadequate to maintain organ perfusion; intervention required (Correct answer)
- Expected in a patient receiving vasodilators
Correct answer: Inadequate to maintain organ perfusion; intervention required
A MAP below 65 mmHg is considered inadequate for organ perfusion and requires prompt intervention to prevent end-organ damage.
PCU Hemodynamic Monitoring & Vascular Access 1
A PCU patient has an arterial line in place.
The nurse notes the waveform is dampened.
What is the most appropriate first action?