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The nurse is caring for a patient who has a history of heart disease. What factor should the nurse identify as possibly contributing to a decrease in cardiac output?
- A. A change in position from standing to sitting
- B. A heart rate of 54 bpm
- C. A pulse oximetry reading of 94%
- D. An increase in preload related to ambulation
Correct Answer: B
Rationale: Cardiac output is computed by multiplying the stroke volume by the heart rate. Cardiac output can be affected by changes in either stroke volume or heart rate, such as a rate of 54 bpm. An increase in preload will lead to an increase in stroke volume. A pulse oximetry reading of 94% does not indicate hypoxemia, as hypoxia can decrease contractility. Transitioning from standing to sitting would more likely increase rather than decrease cardiac output.
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A critical care nurse is caring for a patient with a pulmonary artery catheter in place. What does this catheter measure that is particularly important in critically ill patients?
- A. Pulmonary artery systolic pressure
- B. Right ventricular afterload
- C. Pulmonary artery pressure
- D. Left ventricular preload
Correct Answer: D
Rationale: Monitoring of the pulmonary artery diastolic and pulmonary artery wedge pressures is particularly important in critically ill patients because it is used to evaluate left ventricular filling pressures (i.e., left ventricular preload). This device does not directly measure the other listed aspects of cardiac function.
When hemodynamic monitoring is ordered for a patient, a catheter is inserted into the appropriate blood vessel or heart chamber. When assessing a patient who has such a device in place, the nurse should check which of the following components? Select all that apply.
- A. A transducer
- B. A flush system
- C. A leveler
- D. A pressure bag
- E. An oscillator
Correct Answer: A,B,D
Rationale: To perform hemodynamic monitoring, a CVP, pulmonary artery, or arterial catheter is introduced into the appropriate blood vessel or heart chamber. It is connected to a pressure monitoring system that has several components. Included among these are a transducer, a flush system, and a pressure bag. A pressure monitoring system does not have a leveler or an oscillator.
The critical care nurse is caring for a patient who has been experiencing bradycardia after cardiovascular surgery. The nurse knows that the heart rate is determined by myocardial cells with the fastest inherent firing rate. Under normal circumstances where are these cells located?
- A. SA node
- B. AV node
- C. Bundle of His
- D. Purkinje cells
Correct Answer: A
Rationale: The heart rate is determined by the myocardial cells with the fastest inherent firing rate. Under normal circumstances, the SA node has the highest inherent rate (60 to 100 impulses per minute).
A patient with a complex cardiac history is scheduled for transthoracic echocardiography. What should the nurse teach the patient in anticipation of this diagnostic procedure?
- A. The test is noninvasive, and nothing will be inserted into the patients body
- B. The patients pain will be managed aggressively during the procedure
- C. The test will provide a detailed profile of the hearts electrical activity
- D. The patient will remain on bed rest for 1 to 2 hours after the test
Correct Answer: A
Rationale: Before transthoracic echocardiography, the nurse informs the patient about the test, explaining that it is painless. The test does not evaluate electrophysiology and bed rest is unnecessary after the procedure.
During a shift assessment, the nurse is identifying the clients point of maximum impulse (PMI). Where will the nurse best palpate the PMI?
- A. Left midclavicular line of the chest at the level of the nipple
- B. Left midclavicular line of the chest at the fifth intercostal space
- C. Midline between the xiphoid process and the left nipple
- D. Two to three centimeters to the left of the sternum
Correct Answer: B
Rationale: The left ventricle is responsible for the apical beat or the point of maximum impulse, which is normally palpated in the left midclavicular line of the chest wall at the fifth intercostal space.