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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.
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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.
A critical care nurse is caring for a patient with a hemodynamic monitoring system in place. For what complications should the nurse assess? Select all that apply.
- A. Pneumothorax
- B. Infection
- C. Atelectasis
- D. Bronchospasm
- E. Air embolism
Correct Answer: A,B,E
Rationale: Complications from use of hemodynamic monitoring systems are uncommon, but can include pneumothorax, infection, and air embolism. Complications of hemodynamic monitoring systems do not include atelectasis or bronchospasm.
The nurse is relating the deficits in a patients synchronization of the atrial and ventricular events to his diagnosis. What are the physiologic characteristics of the nodal and Purkinje cells that provide this synchronization? Select all that apply.
- A. Loop connectivity
- B. Excitability
- C. Automaticity
- D. Conductivity
- E. Independence
Correct Answer: B,C,D
Rationale: Three physiologic characteristics of two types of specialized electrical cells, the nodal cells and the Purkinje cells, provide this synchronization: automaticity, or the ability to initiate an electrical impulse; excitability, or the ability to respond to an electrical impulse; and conductivity, the ability to transmit an electrical impulse from one cell to another. Loop connectivity is a distracter for this question. Independence of the cells has nothing to do with the synchronization described in the scenario.
A patient is brought into the ED by family members who tell the nurse the patient grabbed his chest and complained of substernal chest pain. The care team recognizes the need to monitor the patients cardiac function closely while interventions are performed. What form of monitoring should the nurse anticipate?
- A. Left-sided heart catheterization
- B. Cardiac telemetry
- C. Transesophageal echocardiography
- D. Hardwire continuous ECG monitoring
Correct Answer: D
Rationale: Two types of continuous ECG monitoring techniques are used in health care settings: hardwire cardiac monitoring, found in EDs, critical care units, and progressive care units; and telemetry, found in general nursing care units or outpatient cardiac rehabilitation programs. Cardiac catheterization and transesophageal echocardiography would not be used in emergent situations to monitor cardiac function.
The nurse is conducting patient teaching about cholesterol levels. When discussing the patients elevated LDL and lowered HDL levels, the patient shows an understanding of the significance of these levels by stating what?
- A. Increased LDL and decreased HDL increase my risk of coronary artery disease
- B. Increased LDL has the potential to decrease my risk of heart disease
- C. The decreased HDL level will increase the amount of cholesterol moved away from the artery walls
- D. The increased LDL will decrease the amount of cholesterol deposited on the artery walls
Correct Answer: A
Rationale: Elevated LDL levels and decreased HDL levels are associated with a greater incidence of coronary artery disease.