PCU Hemodynamic Monitoring & Vascular Access 3

Question 1

The nurse is caring for a PCU patient on a norepinephrine infusion. The patient's blood pressure drops suddenly. Which assessment should the nurse perform first?

Accepted Answer

Check the IV site for infiltration and verify the infusion is patent and correctly dosed

Answer

Increase the norepinephrine dose by 2 mcg/kg/min

Answer

Administer a 500 mL normal saline bolus immediately

Answer

Obtain a 12-lead ECG

Question 2

Which type of vascular access device is MOST appropriate for long-term IV therapy exceeding 6 months, such as chemotherapy or TPN?

Accepted Answer

Implanted port (port-a-cath)

Answer

Peripheral IV catheter

Answer

Non-tunneled central venous catheter

Answer

Midline catheter

Question 3

A patient's cardiac output (CO) is 3.8 L/min and body surface area (BSA) is 1.9 m². What is the cardiac index (CI) and how should the nurse interpret it?

Accepted Answer

CI = 2.0 L/min/m²; indicates low cardiac output state

Answer

CI = 2.0 L/min/m²; within normal limits

Answer

CI = 7.2 L/min/m²; indicates hyperdynamic state

Answer

CI = 1.9 L/min/m²; indicates severe heart failure

Question 4

When assessing a central venous catheter insertion site, which finding requires immediate removal of the catheter?

Accepted Answer

Purulent drainage, erythema, and tenderness at the site

Answer

Slight bruising at the insertion site on day 1

Answer

Transparent dressing with visible catheter position

Answer

A small amount of dried blood under the dressing

Question 5

A nurse is preparing to draw blood cultures from a patient's central venous catheter. Which practice is correct?

Accepted Answer

Wipe the hub with a 70% alcohol or chlorhexidine swab and allow it to dry before accessing

Answer

Discard the first 5–10 mL of blood before drawing the culture specimen

Answer

Draw cultures from the port most recently used for medication infusion

Answer

Draw cultures immediately after administering antibiotics to evaluate efficacy

Question 6

Which hemodynamic pattern is consistent with hypovolemic shock in a PCU patient?

Accepted Answer

Low CVP, low PAWP, low CO, high SVR

Answer

Low CVP, low PAWP, high CO, low SVR

Answer

High CVP, high PAWP, low CO, high SVR

Answer

Low CVP, high PAWP, high CO, low SVR

Question 7

A PCU patient with a PICC line develops sudden arm swelling, pain, and erythema along the upper extremity. Which complication should the nurse suspect and what is the priority action?

Accepted Answer

Upper extremity deep vein thrombosis (DVT); notify the physician and anticipate orders for Doppler ultrasound

Answer

PICC migration; reposition the catheter tip under fluoroscopy

Answer

Phlebitis; remove the PICC and apply warm compresses

Answer

Air embolism; place the patient in left lateral Trendelenburg