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NR 341 Complex Adult Health
Exam 2 Advanced Critical Care
Nursing Examination
Section 1: Hemodynamic Monitoring & Cardiovascular Assessment (Questions 1-
25)
1. A patient with a pulmonary artery catheter has a cardiac output (CO) of 3.2
L/min and a cardiac index (CI) of 1.6 L/min/m². Which intervention should the
nurse anticipate first?
A) Administer a fluid bolus of 500 mL normal saline
B) Prepare for insertion of an intra-aortic balloon pump
C) Administer dobutamine as prescribed
D) Position the patient in Trendelenburg position
Correct Answer: C
Rationale: A CI of 1.6 L/min/m² (normal 2.8-4.2) indicates cardiogenic shock with
, 2
severely depressed cardiac function. Dobutamine is a positive inotrope that
improves contractility and cardiac output. While fluid resuscitation may be
indicated based on preload, the CI is dangerously low and requires immediate
inotropic support .
2. The nurse is setting up an arterial pressure monitoring system. At which
location should the transducer be leveled to ensure accurate readings?
A) The patient's sternal angle
B) The phlebostatic axis at the 4th intercostal space
C) The patient's right atrium at the mid-axillary line
D) The level of the patient's clavicle
Correct Answer: B
Rationale: The transducer should be leveled at the phlebostatic axis, which is the
intersection of the 4th intercostal space at the mid-axillary line. This corresponds
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to the level of the right atrium. Incorrect leveling leads to false readings:
positioning the transducer too high causes falsely low readings, while too low
causes falsely high readings .
3. A patient with septic shock has the following hemodynamic values: CVP 12
mmHg, PAOP 18 mmHg, SVR 450 dynes/sec/cm⁻⁵, CO 6.5 L/min. Which
intervention is most appropriate?
A) Administer norepinephrine
B) Administer a 500 mL fluid bolus
C) Start dobutamine infusion
D) Administer furosemide
Correct Answer: A
Rationale: The patient has low SVR (normal 800-1200) indicating vasodilation
characteristic of septic shock. Elevated CVP and PAOP indicate adequate or high
, 4
preload, so fluids would not be appropriate. Norepinephrine is the first-line
vasopressor for septic shock to increase SVR and restore blood pressure .
4. During pulmonary artery catheter insertion, the waveform changes from a
right ventricular waveform to a pulmonary artery waveform. What is the nurse's
priority action?
A) Inflate the balloon to obtain PAOP
B) Document the waveform change
C) Deflate the balloon immediately
D) Prepare for PAOP measurement
Correct Answer: C
Rationale: The balloon should be deflated immediately after the catheter passes
through the right ventricle to prevent damage to the pulmonary artery. The
NR 341 Complex Adult Health
Exam 2 Advanced Critical Care
Nursing Examination
Section 1: Hemodynamic Monitoring & Cardiovascular Assessment (Questions 1-
25)
1. A patient with a pulmonary artery catheter has a cardiac output (CO) of 3.2
L/min and a cardiac index (CI) of 1.6 L/min/m². Which intervention should the
nurse anticipate first?
A) Administer a fluid bolus of 500 mL normal saline
B) Prepare for insertion of an intra-aortic balloon pump
C) Administer dobutamine as prescribed
D) Position the patient in Trendelenburg position
Correct Answer: C
Rationale: A CI of 1.6 L/min/m² (normal 2.8-4.2) indicates cardiogenic shock with
, 2
severely depressed cardiac function. Dobutamine is a positive inotrope that
improves contractility and cardiac output. While fluid resuscitation may be
indicated based on preload, the CI is dangerously low and requires immediate
inotropic support .
2. The nurse is setting up an arterial pressure monitoring system. At which
location should the transducer be leveled to ensure accurate readings?
A) The patient's sternal angle
B) The phlebostatic axis at the 4th intercostal space
C) The patient's right atrium at the mid-axillary line
D) The level of the patient's clavicle
Correct Answer: B
Rationale: The transducer should be leveled at the phlebostatic axis, which is the
intersection of the 4th intercostal space at the mid-axillary line. This corresponds
, 3
to the level of the right atrium. Incorrect leveling leads to false readings:
positioning the transducer too high causes falsely low readings, while too low
causes falsely high readings .
3. A patient with septic shock has the following hemodynamic values: CVP 12
mmHg, PAOP 18 mmHg, SVR 450 dynes/sec/cm⁻⁵, CO 6.5 L/min. Which
intervention is most appropriate?
A) Administer norepinephrine
B) Administer a 500 mL fluid bolus
C) Start dobutamine infusion
D) Administer furosemide
Correct Answer: A
Rationale: The patient has low SVR (normal 800-1200) indicating vasodilation
characteristic of septic shock. Elevated CVP and PAOP indicate adequate or high
, 4
preload, so fluids would not be appropriate. Norepinephrine is the first-line
vasopressor for septic shock to increase SVR and restore blood pressure .
4. During pulmonary artery catheter insertion, the waveform changes from a
right ventricular waveform to a pulmonary artery waveform. What is the nurse's
priority action?
A) Inflate the balloon to obtain PAOP
B) Document the waveform change
C) Deflate the balloon immediately
D) Prepare for PAOP measurement
Correct Answer: C
Rationale: The balloon should be deflated immediately after the catheter passes
through the right ventricle to prevent damage to the pulmonary artery. The
