Deck 11: Hemodynamic Monitoring

Question 1

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 1

Ejection fraction

Question 2

While attempting to draw blood from an indwelling arterial catheter,the respiratory therapist notices a dampened waveform and has difficulty withdrawing 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 2

Remove the catheter.

Question 3

Which of the following 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

Answer 3

1 and 4 only

Question 4

The measurement that can be used to estimate right ventricular preload is which of the following?

A) Cardiac Output
B) Central Venous Pressure
C) Pulmonary Artery Pressure
D) Pulmonary Artery Occlusion Pressure

Question 5

The main component of a hemodynamic monitoring system is which of the following?

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

Question 6

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) Drawing a blood sample through the catheter

Question 7

An increase in systemic vascular resistance will cause which of the following to occur?

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

Question 8

The most determining factor for preload is which of the following?

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

Question 9

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

Question 10

The filling pressure of the ventricle at the end of ventricular diastole is known as which of the following?

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

Question 11

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 12

The respiratory therapist preparing to insert an arterial line in the right radial artery performs an Allen's test.The result of the Allen's 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's test on the right hand.
C) Perform an Allen's test on the left hand.
D) Recommend a surgical cut down at the right radial site.

Question 13

The complications that may occur during the insertion of a central venous pressure line include all of the following except:

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

Question 14

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 15

The function of the transducer in the invasive vascular monitoring system is to do which of the following?

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 16

Left ventricular afterload is indicated by which of the following?

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

Question 17

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 18

The vessels that often require a surgical cut down when used for pulmonary artery catheter access include which of the following?
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 19

Common complications of systemic artery catheterization include all but which of the following?

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

Question 20

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 21

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,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 22

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 23

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 seconds

Question 24

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 25

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

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

Question 26

Excessive pulmonary artery catheter movement can cause which of the following to occur?

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

Question 27

Calculate the arterial oxygen content for a patient with the following arterial blood gas measurements: Hgb = 9 g%,arterial oxygen saturation (S_aO₂)= 96%,arterial partial pressure of oxygen (P_aO₂)= 97 mm Hg.

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

Question 28

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 29

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 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

Calculate cardiac output using the Fick Principle for the following values:

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

Question 32

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 33

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 34

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 35

A patient with the hemodynamic values below has a cardiac output of which of the following?

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

Question 36

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

A) 0.26 m^2/L/min
B) 3.8 L/min/m²
C) 5.5 L/min-m²
D) 5.8 m²/L/min

Question 37

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 beat per minutes,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 38

Calculate the arterial oxygen content for a patient with the following arterial blood gas measurements: Hgb = 17 g%,arterial oxygen saturation (S_aO₂)= 93%,arterial partial pressure of oxygen (P_aO₂)= 64 mm Hg.

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

Question 39

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 40

The most appropriate insertion site(s)for a pulmonary catheter in a patient with phlebitis include which of the following?
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 41

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 x sec x cm^-5
B) 267 dyne x sec x cm^-5
C) 317 dyne x sec x cm^-5
D) 1,496 dyne x sec x cm^-5

Question 42

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 43

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 44

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 45

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 46

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 47

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 x sec x cm^-5
B) 393 dyne x sec x cm^-5
C) 800 dyne x sec x cm^-5
D) 1,165 dyne x sec x cm^-5

Question 48

An increase in systemic vascular resistance can be elevated by which of the following disorders?

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

Question 49

The hemodynamic parameter that is not within normal limits includes which of the following?

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 x sec x cm^-5

Question 50

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

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 51

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 52

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 x sec x cm^-5
B) 393 dyne x sec x cm^-5
C) 800 dyne x sec x cm^-5
D) 1,165 dyne x sec x cm^-5

Question 53

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 54

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 bpm,set tidal volume (V_T)400 mL,positive-end-expiratory pressure (PEEP)18 cm H2O,fractional inspired oxygen (FIO₂)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 (P_aCO₂)38 mm Hg,arterial partial pressure of oxygen (P_aO₂)90 mm Hg.The physician asks for recommendations to improve this patient's hemodynamics.The 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,recheck hemodynamics measurements.
D) Change to pressure controlled continuous mandatory ventilation (PC-CMV),peak inspiratory pressure (PIP)25 cm H₂O,PEEP 18 cm H₂O,FIO₂ 0.35 and check PAP.

Question 55

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 x sec x cm^-5
B) 267 dyne x sec x cm^-5
C) 317 dyne x sec x cm^-5
D) 1,496 dyne x sec x cm^-5