NUR 265 GALEN EXAM 4 2026/2027 | Critical Care & Complex
Adult Health Validation | 100% Correct Answers | Pass
Guaranteed - A+ Graded
SECTION 1: CRITICAL CARE & HEMODYNAMIC MONITORING
(QUESTIONS 1-10)
Q1. A nurse is caring for a patient with a pulmonary artery catheter (PAC) in place. The
waveform shows a mean CVP of 18 mmHg with prominent a and v waves, and the x and
y descents appear blunted. The patient is hypotensive with muffled heart sounds and
jugular venous distension. Which hemodynamic parameter should the nurse anticipate
will be most significantly altered?
A. Cardiac output will be elevated due to increased preload
B. Pulmonary artery wedge pressure will be decreased
C. Cardiac output will be decreased due to impaired ventricular filling
D. Systemic vascular resistance will be decreased
C. Cardiac output will be decreased due to impaired ventricular filling [CORRECT]
Rationale: The waveform description (elevated CVP with blunted x and y descents,
prominent a and v waves) combined with hypotension, muffled heart sounds, and JVD is
classic for cardiac tamponade. In tamponade, pericardial fluid restricts ventricular
filling, leading to decreased stroke volume and cardiac output. The other options are
incorrect: preload is not truly increased (it is restricted), PAOP is typically elevated or
normal (not decreased), and SVR is usually increased as a compensatory mechanism.
Correct Answer: C
,Q2. A critical care nurse is zeroing an arterial line transducer. The phlebostatic axis is
identified at the fourth intercostal space at the mid-axillary line. The patient is now
placed in a semi-Fowler's position at 45 degrees. Which action by the nurse is most
appropriate to maintain accurate arterial pressure readings?
A. Keep the transducer at the level of the right atrium and add 5 mmHg to all readings
B. Maintain the transducer at the phlebostatic axis regardless of patient position
C. Lower the transducer to the level of the patient's head to compensate for gravity
D. Recalibrate the transducer every 15 minutes while the patient remains elevated
B. Maintain the transducer at the phlebostatic axis regardless of patient position
[CORRECT]
Rationale: The phlebostatic axis (fourth intercostal space, mid-axillary line) is the
standard reference point for hemodynamic monitoring and corresponds to the level of
the right atrium. The transducer must remain at this level regardless of patient position
changes to ensure accurate pressure readings. Moving the transducer or adding
arbitrary values introduces measurement error. Recalibration is not required with
position changes if the reference level is maintained.
Correct Answer: B
Q3. During pulmonary artery catheter insertion, the nurse observes the waveform
transition from a right ventricular waveform (systolic pressure 25 mmHg, diastolic
pressure 5 mmHg) to a pulmonary artery waveform (systolic pressure 25 mmHg,
diastolic pressure 12 mmHg). Which nursing action is the priority at this time?
A. Inflate the balloon immediately to obtain a wedge pressure reading
B. Document the waveform change and continue monitoring for further advancement
C. Advance the catheter 2-3 cm further until a wedge waveform is obtained
,D. Deflate the balloon and notify the provider that the catheter is in the pulmonary artery
B. Document the waveform change and continue monitoring for further advancement
[CORRECT]
Rationale: The waveform change from RV to PA is expected during catheter flotation.
The nurse should document this transition and continue monitoring. The catheter
should not be advanced further without provider direction, and the balloon should not be
inflated until the catheter is in the proper PA position and confirmed by chest x-ray.
Premature balloon inflation can cause PA rupture or cardiac perforation.
Correct Answer: B
Q4. A patient in septic shock has the following hemodynamic parameters: MAP 58
mmHg, CVP 4 mmHg, PAOP 6 mmHg, CI 2.1 L/min/m², SVR 800 dynes/sec/cm⁻⁵.
Based on these findings, which intervention should the nurse anticipate as the priority?
A. Administer a vasopressor to increase systemic vascular resistance
B. Administer a fluid bolus of crystalloid solution
C. Initiate an inotropic agent to improve cardiac contractility
D. Prepare the patient for emergent dialysis
B. Administer a fluid bolus of crystalloid solution [CORRECT]
Rationale: The hemodynamic profile shows low preload (CVP 4, PAOP 6), low cardiac
index (2.1), and low SVR (800) with hypotension (MAP 58). This is consistent with
hypovolemic, hyperdynamic septic shock. The priority is fluid resuscitation to restore
preload and improve cardiac output per the 2026 Surviving Sepsis Campaign guidelines.
Vasopressors would be added only after adequate fluid resuscitation if hypotension
persists. Inotropes are not indicated as the primary issue is preload, not contractility.
, Correct Answer: B
Q5. The nurse is monitoring a patient with an arterial line and observes the waveform
showing a dicrotic notch that is lower than usual and a narrowed pulse pressure. The
patient's blood pressure is 88/62 mmHg. Which condition should the nurse suspect?
A. Increased stroke volume with decreased afterload
B. Decreased stroke volume with increased afterload
C. Aortic regurgitation with widened pulse pressure
D. Hypovolemia with decreased stroke volume
D. Hypovolemia with decreased stroke volume [CORRECT]
Rationale: A narrowed pulse pressure (26 mmHg) with a low dicrotic notch indicates
decreased stroke volume, which is characteristic of hypovolemia. The arterial waveform
reflects reduced ventricular filling and decreased cardiac output. Increased stroke
volume would produce a widened pulse pressure, and aortic regurgitation would show a
bounding pulse with a wide pulse pressure, not a narrowed one.
Correct Answer: D
Q6. A patient with cardiogenic shock has the following hemodynamic values: MAP 62
mmHg, CVP 18 mmHg, PAOP 28 mmHg, CI 1.8 L/min/m², SVR 1800 dynes/sec/cm⁻⁵.
The nurse is preparing to administer prescribed medications. Which medication should
the nurse anticipate will be most beneficial for this patient?
A. Dobutamine to increase cardiac contractility and reduce afterload
B. Norepinephrine to increase systemic vascular resistance
C. Nitroprusside to decrease preload and afterload
D. Phenylephrine to increase venous return
Adult Health Validation | 100% Correct Answers | Pass
Guaranteed - A+ Graded
SECTION 1: CRITICAL CARE & HEMODYNAMIC MONITORING
(QUESTIONS 1-10)
Q1. A nurse is caring for a patient with a pulmonary artery catheter (PAC) in place. The
waveform shows a mean CVP of 18 mmHg with prominent a and v waves, and the x and
y descents appear blunted. The patient is hypotensive with muffled heart sounds and
jugular venous distension. Which hemodynamic parameter should the nurse anticipate
will be most significantly altered?
A. Cardiac output will be elevated due to increased preload
B. Pulmonary artery wedge pressure will be decreased
C. Cardiac output will be decreased due to impaired ventricular filling
D. Systemic vascular resistance will be decreased
C. Cardiac output will be decreased due to impaired ventricular filling [CORRECT]
Rationale: The waveform description (elevated CVP with blunted x and y descents,
prominent a and v waves) combined with hypotension, muffled heart sounds, and JVD is
classic for cardiac tamponade. In tamponade, pericardial fluid restricts ventricular
filling, leading to decreased stroke volume and cardiac output. The other options are
incorrect: preload is not truly increased (it is restricted), PAOP is typically elevated or
normal (not decreased), and SVR is usually increased as a compensatory mechanism.
Correct Answer: C
,Q2. A critical care nurse is zeroing an arterial line transducer. The phlebostatic axis is
identified at the fourth intercostal space at the mid-axillary line. The patient is now
placed in a semi-Fowler's position at 45 degrees. Which action by the nurse is most
appropriate to maintain accurate arterial pressure readings?
A. Keep the transducer at the level of the right atrium and add 5 mmHg to all readings
B. Maintain the transducer at the phlebostatic axis regardless of patient position
C. Lower the transducer to the level of the patient's head to compensate for gravity
D. Recalibrate the transducer every 15 minutes while the patient remains elevated
B. Maintain the transducer at the phlebostatic axis regardless of patient position
[CORRECT]
Rationale: The phlebostatic axis (fourth intercostal space, mid-axillary line) is the
standard reference point for hemodynamic monitoring and corresponds to the level of
the right atrium. The transducer must remain at this level regardless of patient position
changes to ensure accurate pressure readings. Moving the transducer or adding
arbitrary values introduces measurement error. Recalibration is not required with
position changes if the reference level is maintained.
Correct Answer: B
Q3. During pulmonary artery catheter insertion, the nurse observes the waveform
transition from a right ventricular waveform (systolic pressure 25 mmHg, diastolic
pressure 5 mmHg) to a pulmonary artery waveform (systolic pressure 25 mmHg,
diastolic pressure 12 mmHg). Which nursing action is the priority at this time?
A. Inflate the balloon immediately to obtain a wedge pressure reading
B. Document the waveform change and continue monitoring for further advancement
C. Advance the catheter 2-3 cm further until a wedge waveform is obtained
,D. Deflate the balloon and notify the provider that the catheter is in the pulmonary artery
B. Document the waveform change and continue monitoring for further advancement
[CORRECT]
Rationale: The waveform change from RV to PA is expected during catheter flotation.
The nurse should document this transition and continue monitoring. The catheter
should not be advanced further without provider direction, and the balloon should not be
inflated until the catheter is in the proper PA position and confirmed by chest x-ray.
Premature balloon inflation can cause PA rupture or cardiac perforation.
Correct Answer: B
Q4. A patient in septic shock has the following hemodynamic parameters: MAP 58
mmHg, CVP 4 mmHg, PAOP 6 mmHg, CI 2.1 L/min/m², SVR 800 dynes/sec/cm⁻⁵.
Based on these findings, which intervention should the nurse anticipate as the priority?
A. Administer a vasopressor to increase systemic vascular resistance
B. Administer a fluid bolus of crystalloid solution
C. Initiate an inotropic agent to improve cardiac contractility
D. Prepare the patient for emergent dialysis
B. Administer a fluid bolus of crystalloid solution [CORRECT]
Rationale: The hemodynamic profile shows low preload (CVP 4, PAOP 6), low cardiac
index (2.1), and low SVR (800) with hypotension (MAP 58). This is consistent with
hypovolemic, hyperdynamic septic shock. The priority is fluid resuscitation to restore
preload and improve cardiac output per the 2026 Surviving Sepsis Campaign guidelines.
Vasopressors would be added only after adequate fluid resuscitation if hypotension
persists. Inotropes are not indicated as the primary issue is preload, not contractility.
, Correct Answer: B
Q5. The nurse is monitoring a patient with an arterial line and observes the waveform
showing a dicrotic notch that is lower than usual and a narrowed pulse pressure. The
patient's blood pressure is 88/62 mmHg. Which condition should the nurse suspect?
A. Increased stroke volume with decreased afterload
B. Decreased stroke volume with increased afterload
C. Aortic regurgitation with widened pulse pressure
D. Hypovolemia with decreased stroke volume
D. Hypovolemia with decreased stroke volume [CORRECT]
Rationale: A narrowed pulse pressure (26 mmHg) with a low dicrotic notch indicates
decreased stroke volume, which is characteristic of hypovolemia. The arterial waveform
reflects reduced ventricular filling and decreased cardiac output. Increased stroke
volume would produce a widened pulse pressure, and aortic regurgitation would show a
bounding pulse with a wide pulse pressure, not a narrowed one.
Correct Answer: D
Q6. A patient with cardiogenic shock has the following hemodynamic values: MAP 62
mmHg, CVP 18 mmHg, PAOP 28 mmHg, CI 1.8 L/min/m², SVR 1800 dynes/sec/cm⁻⁵.
The nurse is preparing to administer prescribed medications. Which medication should
the nurse anticipate will be most beneficial for this patient?
A. Dobutamine to increase cardiac contractility and reduce afterload
B. Norepinephrine to increase systemic vascular resistance
C. Nitroprusside to decrease preload and afterload
D. Phenylephrine to increase venous return
