Deck 11: Hemodynamic Monitoring

Question 1

During the insertion of a pulmonary artery catheter,the balloon needs to be inflated with air when it enters which of the following?

A) Right atrium
B) Right ventricle
C) Pulmonary artery
D) Intrathoracic vessel

Answer 1

D
The balloon must be inflated as soon as it enters the intrathoracic vessel so that the catheter may be flow-directed by the balloon through the blood into the right atrium,right ventricle,and pulmonary artery.The inflation of the balloon also protects the heart from endocardial and pulmonary artery damage and ventricular arrhythmias.

Question 2

Which of the following can be used to estimate the contractility of the ventricles?

A) Ejection fraction
B) Systemic vascular resistance
C) Pulmonary vascular resistance
D) Right and left ventricular end-diastolic pressure

Answer 2

A
The ejection fraction is a way of estimating the force that the ventricle generates during each cardiac cycle.It is calculated as the ratio of the stroke volume to the ventricular end-diastolic volume.Systemic vascular resistance is used to describe the afterload that the left ventricle must overcome to eject blood into the systemic circulation.The pulmonary vascular resistance reflects the afterload that the right ventricle must overcome to eject blood into the pulmonary circulation.The right ventricular end-diastolic pressure is used as an indicator of the right ventricular preload and the left ventricular end-diastolic pressure is used to indicate left ventricular preload.

Question 3

While attempting to dRₐᴡblood from an indwelling arterial catheter,the respiratory therapist notices a dampened waveform and has difficulty withdRₐᴡing blood for sampling.What should the respiratory therapist's immediate action be?

A) Flush the catheter.
B) Remove the catheter.
C) Reposition the catheter.
D) Recalibrate the transducer.

Answer 3

B
The presence of both a persistently dampened waveform and difficulty withdRₐᴡing blood indicates that there is a clot.To avoid any adverse effects the catheter should be removed.Flushing the catheter could cause the blood clot to move into the patient's circulation and has the potential to cause an infarction in the brain,heart,or lungs.Repositioning the catheter will not remove the clot.Recalibrating the transducer will not remove the clot.

Question 4

Which of the following is the function of the transducer in the invasive vascular monitoring system?

A) Measure the flow of fluid in the catheter.
B) Convert the fluid pressure to an electrical signal.
C) Connect to the thermistor to measure cardiac output.
D) Amplify the electrical signal so it may be seen on the monitor.

Question 5

Which of the following measurements can be used to estimate right ventricular preload?

A) Cardiac output
B) Central venous pressure
C) Pulmonary artery pressure
D) Pulmonary artery occlusion pressure

Question 6

Which of the following is the main component of a hemodynamic monitoring system?

A) Plethysmograph
B) Pneumotachometer
C) Sphygmomanometer
D) Strain gauge transducer

Question 7

What is the most determining factor for preload?

A) Contractility
B) Venous return
C) Ejection fraction
D) Vascular resistance

Question 8

Absolute confirmation of placement of a central venous pressure catheter is done with which of the following?

A) Chest X-ray
B) Checking the centimeter mark
C) Ensuring appropriate waveform
D) DRₐᴡing a blood sample through the catheter

Question 9

While checking an indwelling central venous pressure (CVP)catheter the respiratory therapist observes that the transducer is at the epistatic line.The respiratory therapist should do which of the following at this time?

A) Zero the pressure transducer.
B) Raise the pressure transducer.
C) Accept the CVP reading obtained.
D) Recalibrate the pressure transducer.

Question 10

Calculate the ejection fraction of a female patient with a stroke volume of 40 mL and an end-diastolic volume of 125 mL.

A) 0.32
B) 3.1
C) 85
D) 165

Question 11

Which of the following is not a complication that may occur during the insertion of a central venous pressure line?

A) Bleeding
B) Infection
C) Pneumothorax
D) Vessel damage

Question 12

Which of the following are vessels that often require a surgical cut down when used for pulmonary artery catheter access?
1)Femoral vein
2)Subclavian vein
3)Internal jugular vein
4)Antecubital vein

A) 1 and 2 only
B) 1 and 4 only
C) 2 and 4 only
D) 2 and 3 only

Question 13

During the introduction of a pulmonary artery catheter the waveform seen in the figure is visible on the monitor.This waveform represents which of the following locations?

A) Right atrium
B) Right ventricle
C) Pulmonary artery
D) Pulmonary capillary

Question 14

Which measurement is typically used to indicate right ventricular preload?

A) Right atrial pressure (RAP)
B) Pulmonary artery occlusion pressure (PAOP)
C) Right ventricular end-diastolic pressure (RVEDP)
D) Ejection fraction

Question 15

Which of the following will cause an increase in systemic vascular resistance?

A) Decrease left ventricular preload.
B) Increase right ventricular preload.
C) Increase left ventricular afterload.
D) Decrease right ventricular afterload.

Question 16

Which of the following is not a common complication of systemic artery catheterization?

A) Phlebitis
B) Ischemia
C) Hematoma
D) Hemorrhage

Question 17

The respiratory therapist preparing to insert an arterial line in the right radial artery performs an Allen test.The result of the Allen test is 20 seconds.The respiratory therapist should do which of the following?

A) Insert the cannula into the right radial artery.
B) Repeat the Allen test on the right hand.
C) Perform an Allen test on the left hand.
D) Recommend a surgical cut down at the right radial site.

Question 18

Which of the following statements is true concerning the insertion of a radial arterial line?
1)The catheter tip must face upstream.
2)The catheter tip must face downstream.
3)The transducer must be higher than the catheter tip.
4)The transducer must be level with the catheter tip.

A) 1 and 3 only
B) 1 and 4 only
C) 2 and 3 only
D) 2 and 4 only

Question 19

Which of the following is an indication of left ventricular afterload?

A) Ejection fraction
B) Systemic vascular resistance
C) Pulmonary vascular resistance
D) Left ventricular end-diastolic pressure

Question 20

Which of the following describes the filling pressure of the ventricle at the end of ventricular diastole?

A) Preload
B) Afterload
C) Dicrotic notch
D) Ejection fraction

Question 21

Calculate the cardiac index for a patient with the following data: heart rate = 80 beats/min,stroke volume = 55 mL,and body surface area = 2.8 m².

A) 0.57 L/min/m²
B) 1.6 L/min/m²
C) 7.2 L/min/m²
D) 19.6 L/min/m²

Question 22

Calculate the stroke volume (SV)and the stroke volume index (SI)using the following information: cardiac output = 4.5 L/min,heart rate = 110 beats/min,and body surface area = 1.3 m².

A) SV = 41 mL; SI = 31.5 mL/m²
B) SV = 45 mL; SI = 34.3 mL/m²
C) SV = 46 mL; SI = 36 mL/m²
D) SV = 49.5 mL; SI = 38 mL/m²

Question 23

Which of the following is the range for the time a pulmonary artery catheter should be inflated?

A) 5-10 seconds
B) 15-30 seconds
C) 30-60 seconds
D) 60-120 seconds

Question 24

Calculate the cardiac index using the following data:
Cardiac output = 4.6 L/min
Body surface area = 1.2 m²

A) 0.26 m²/L/min
B) 3.8 L/min/m²
C) 5.5 L/min-m²
D) 5.8 m²/L/min

Question 25

Calculate the right ventricular stroke work (RVSW)for a patient with the following measurements: pulmonary artery pressure (PAP)50/32 mm Hg,cardiac output (C.O.)4.0 L/min,heart rate (HR)127/min,and body surface area (BSA)1.72 m².

A) 0.11 g-m/m²
B) 4.5 g-m/m²
C) 9.5 g-m/m²
D) 10.2 g-m/m²

Question 26

The hemodynamic values for a patient in the cardiovascular care unit are: blood pressure (BP)96/60 mm Hg,pulmonary artery pressure (PAP)29 mm Hg,pulmonary capillary wedge pressure (PCWP)14 mm Hg,stroke volume (SV)50 mL.The patient has a body surface area of 1.6 m².Calculate the patient's left ventricular stroke work (LVSW).

A) 12.3 g-m/m²
B) 30.6 g-m/m²
C) 33.2 g-m/m²
D) 49 g-m/m²

Question 27

Calculate a 90-kg patient's cardiac index with the following measurements: cardiac output 3.8 L/min,body surface area 3 m².

A) 0.79 m²/L/min
B) 0.9 L/min/m²
C) 1.3 L/min/m²
D) 6.9 m²/L/min

Question 28

Which of the following include the most appropriate insertion site(s)for a pulmonary catheter in a patient with phlebitis?
1)Internal jugular vein
2)Subclavian vein
3)Antecubital vein
4)Femoral vein

A) 4 only
B) 1 and 2 only
C) 3 and 4 only
D) 1, 2, and 3 only

Question 29

Calculate the left ventricular stroke work for a patient with a body surface area of 1.1 m²,blood pressure 105/68 mm Hg,heart rate 86 beats per minute,and cardiac output of 4.3 L/min.

A) 10.9 g-m/m²
B) 35.6 g-m/m²
C) 49.5 g-m/m²
D) 54.4 g-m/m²

Question 30

A patient with an oxygen consumption of 340 mL/min,arterial oxygen content of 17.3 vol%,and mixed venous oxygen content of 12.8 vol% has a cardiac output of which of the following?

A) 2 mL/min
B) 2.6 mL/min
C) 7.6 mL/min
D) 11 mL/min

Question 31

A pulmonary artery catheter must be wedged in which of the following locations?

A) Zone 1
B) Zone 2
C) Zone 3
D) Doesn't matter

Question 32

Calculate the stroke index using the following data: cardiac output = 3.7 L/min,heart rate = 90 beats/min,and body surface area = 1.7 m².

A) 0.024 mL/m²
B) 0.41 mL/m²
C) 24 mL/m²
D) 41 mL/m²

Question 33

If the heart rate is 80 beats per minute,how long is one beat?

A) 0.75 second
B) 0.9 second
C) 1 second
D) 1.3 second

Question 34

Calculate the right ventricular stroke work (RVSW)given the following patient data: pulmonary artery pressure (PAP)= 35/25 mm Hg,cardiac output (C.O.)= 3.6 L/min,heart rate (HR)= 107 beats per minute,and body surface area (BSA)is 1.6 m².

A) 1.7 g-m/m²
B) 6.2 g-m/m²
C) 7.1 g-m/m²
D) 30.5 g-m/m²

Question 35

Which of the following can occur with excessive pulmonary artery catheter movement?

A) Catheter whip
B) Balloon rupture
C) Catheter knotting
D) Dampened waveform

Question 36

A patient with the hemodynamic values below has a cardiac output of which of the following?
Oxygen consumption 380 mL/min
Arterial oxygen content 23.2 vol%
Mixed venous oxygen content 10.3 vol%

A) 2.9 mL/min
B) 3.4 mL/min
C) 12.9 mL/min
D) 24.1 mL/min

Question 37

Calculate the arterial oxygen content for a patient with the following arterial blood gas measurements: Hgb = 17 g%,arterial oxygen saturation (SₐO₂)= 93%,arterial partial pressure of oxygen (PₐO₂)= 64 mm Hg.

A) 10.6 vol%
B) 14.6 vol%
C) 16.2 vol%
D) 21.4 vol%

Question 38

Calculate cardiac output using the Fick principle for the following values:
Oxygen consumption 280 mL/min
Arterial oxygen content 19.5 vol%
Mixed venous oxygen content 12 vol%

A) 2.1 L/min
B) 3.7 L/min
C) 7.5 L/min
D) 20.5 L/min

Question 39

Calculate the arterial oxygen content for a patient with the following arterial blood gas measurements: Hgb = 9 g%,arterial oxygen saturation (SₐO₂)= 96%,arterial partial pressure of oxygen (PₐO₂)= 97 mm Hg.

A) 8.6 vol%
B) 11.0 vol%
C) 11.9 vol%
D) 12.1 vol%

Question 40

The waveform of a pulmonary catheter,shown in the figure,is located in which of the following?

A) Right atrium
B) Pulmonary artery
C) Right ventricle
D) Pulmonary capillary with a wedge

Question 41

A patient in the ICU has a chest X-ray that shows bilateral infiltrates and has the following hemodynamic measurements: central venous pressure (CVP)5 mm Hg,pulmonary artery pressure (PAP)24/13 mm Hg,and pulmonary artery occlusion pressure (PAOP)21 mm Hg.These findings are consistent with which of the following?

A) Pulmonary hypertension
B) Right ventricular failure
C) Noncardiogenic pulmonary edema
D) Cardiogenic pulmonary edema

Question 42

A patient with a mitral valve stenosis is most likely to have which of the following pulmonary artery occlusion pressure (PAOP)values?

A) 4 mm Hg
B) 6 mm Hg
C) 12 mm Hg
D) 20 mm Hg

Question 43

Which of the following hemodynamic parameter that is not within normal limits?

A) Cardiac index (CI) = 4 L/min/m²
B) Mixed venous oxygen content (CO₂) = 10 vol%
C) Mean arterial pressure (MAP) = 18 mm Hg
D) Pulmonary vascular resistance (PVR) = 200 dyne × sec × cm⁻⁵

Question 44

Which of the following is the hemodynamic measurement that is indicative of a patient with right heart failure?

A) Pulmonary artery occlusion pressure (PAOP) = 12 mm Hg
B) Central venous pressure (CVP) = 16 mm Hg
C) Pulmonary artery pressure (PAP) = 35/15 mm Hg
D) Mean arterial pressure (MAP) = 80 mm Hg

Question 45

Which of the following disorders can cause an increase in systemic vascular resistance?

A) Lung collapse
B) Hypervolemia
C) Chronic bronchitis
D) Cardiogenic pulmonary edema

Question 46

An intubated patient with no known history of congestive heart failure is in the ICU.The patient is comatose and currently receiving mechanical ventilation via volume-controlled continuous mandatory ventilation (VC-CMV),set rate 12 breaths/min,set tidal volume (Vᴛ)400 mL,positive end-expiratory pressure (PEEP)18 cm H₂O,fractional inspired oxygen (FɪO₂)0.35,and the patient is not assisting.Hemodynamic measurements show the following: central venous pressure (CVP)5 mm Hg,pulmonary artery pressure (PAP)33/20 mm Hg,and pulmonary artery occlusion pressure (PAOP)16 mm Hg.Arterial blood gas (ABG)results are: pH 7.43,arterial partial pressure of carbon dioxide (PₐCO₂)38 mm Hg,arterial partial pressure of oxygen (PₐO₂)90 mm Hg.The physician asks for recommendations to improve this patient's hemodynamiCₛThe most appropriate recommendation for this patient is which of the following?

A) Initiate pressure support ventilation (PSV) 10 cm H₂O with CPAP 10 cm H₂O, and check cardiac output.
B) Decrease the PEEP incrementally and recheck hemodynamic measurements.
C) Change to volume-controlled synchronized intermittent mandatory ventilation (VC-SIMV) with the same settings, and recheck hemodynamic measurements.
D) Change to pressure-controlled continuous mandatory ventilation (PC-CMV), peak inspiratory pressure (PIP) 25 cm H₂O, PEEP 18 cm H₂O, FɪO₂ 0.35, and check PAP.

Question 47

Ventricular contractility can be estimated by which of the following?

A) Systemic vascular resistance
B) Ejection fraction
C) Pulmonary vascular resistance
D) Left ventricular stroke work

Question 48

Advancing a pulmonary artery catheter into a smaller artery may cause which of the following complications?

A) Pneumothorax
B) Air embolism
C) Pulmonary infarction
D) Ventricular fibrillation

Question 49

The following hemodynamic measurements were obtained from a patient in the intensive care unit: pulmonary artery pressure (PAP)= 67/25 mm Hg,pulmonary artery occlusion pressure (PAOP)= 18 mm Hg,blood pressure (BP)= 100/50 mm Hg,central venous pressure (CVP)= 17 mm Hg,cardiac output (C.O.)= 5.7 L/min,and heart rate (HR)= 75 beats/min.Calculate this patient's pulmonary vascular resistance (PVR).

A) 295 dyne × sec × cm⁻⁵
B) 393 dyne × sec × cm⁻⁵
C) 800 dyne × sec × cm⁻⁵
D) 1165 dyne × sec × cm⁻⁵

Question 50

The following hemodynamic measurements were obtained from a patient in the intensive care unit: pulmonary artery pressure (PAP)= 67/25 mm Hg,pulmonary artery occlusion pressure (PAOP)= 18 mm Hg,blood pressure (BP)= 100/50 mm Hg,central venous pressure (CVP)= 17 mm Hg,cardiac output (C.O.)= 5.7 L/min,and heart rate (HR)= 75 beats/min.Calculate this patient's systemic vascular resistance (SVR).

A) 295 dyne × sec × cm⁻⁵
B) 393 dyne × sec × cm⁻⁵
C) 800 dyne × sec × cm⁻⁵
D) 1165 dyne × sec × cm⁻⁵

Question 51

During the inspiratory phase of spontaneous breathing,what happens to the pulmonary artery (PA)waveform?

A) There is no change in the waveform.
B) The PA waveform trend increases.
C) The PA waveform trend decreases.
D) The PA diastolic pressure increases.

Question 52

Which of the following can cause an elevated right arterial pressure?

A) Cardiac tamponade
B) Third-degree heart block
C) Decreased ventricular compliance
D) Left ventricular failure

Question 53

A patient in the ICU has a chest X-ray that shows bilateral infiltrates and has the following hemodynamic measurements: central venous pressure (CVP)3 mm Hg,pulmonary artery pressure (PAP)21/10 mm Hg,and pulmonary artery occlusion pressure (PAOP)8 mm Hg.These findings are consistent with which of the following?

A) Acute respiratory distress syndrome
B) Cardiogenic pulmonary edema
C) Pulmonary hypertension
D) Right heart failure

Question 54

Calculate the pulmonary vascular resistance (PVR)given the following measurements obtained during a hemodynamic study: pulmonary artery pressure (PAP)= 40/22 mm Hg,pulmonary artery occlusion pressure (PAOP)= 12 mm Hg,blood pressure (BP)= 156/80 mm Hg,central venous pressure (CVP)= 19 mm Hg,cardiac output (C.O.)= 4.8 L/min,and heart rate (HR)= 68 beats/min.

A) 150 dyne × sec × cm⁻⁵
B) 267 dyne × sec × cm⁻⁵
C) 317 dyne × sec × cm⁻⁵
D) 1496 dyne × sec × cm⁻⁵

Question 55

A high cardiac output can cause which of the following complications with a pulmonary artery catheter?

A) Pneumothorax
B) Catheter whip
C) Pulmonary infarction
D) Catheter knotting

Question 56

Calculate the systemic vascular resistance (SVR)given the following measurements obtained during a hemodynamic study: pulmonary artery pressure (PAP)= 40/22 mm Hg,pulmonary artery occlusion pressure (PAOP)= 12 mm Hg,blood pressure (BP)= 156/80 mm Hg,central venous pressure (CVP)= 19 mm Hg,cardiac output (C.O.)= 4.8 L/min,and heart rate (HR)= 68 beats/min.

A) 150 dyne × sec × cm⁻⁵
B) 267 dyne × sec × cm⁻⁵
C) 317 dyne × sec × cm⁻⁵
D) 1496 dyne × sec × cm⁻⁵