CCRN questions Hemodynamics Updated 2024/2025 Verified 100%

One hemodynamic benefit of intra-aortic balloon therapy is: A) Balloon inflation prevents right to left shunt B) Balloon deflation increases coronary artery perfusion C) Balloon inflation optimizes aortic valve performance D) Balloon deflation decreases left ventricular afterload - D) Balloon deflation decreases left ventricular afterload Which of the following hemodynamic profiles would benefit from aggressive fluid administration, pressors and antibiotic therapy? A) RAP 1, PAOP 4, SVR 1800, CO 2 L/min B) RAP 5, PAOP 7, SVR 400, CO 8 L/min C) RAP 5, PAOP 17, SVR 1900, CO 2 L/min D) RAP 12, PAOP 7, SVR 1400, CO 5 L/min - B) RAP 5, PAOP 7, SVR 400, CO 8 L/min The nurse needs to assess adequacy of the tubing/catheter system for the arterial line. Which of the following interventions will best assess this? A) Use heparinized flush B) Level the transducer C) Zero balance the transducer D) Perform a square wave test - D) Perform a square wave test Use of heparin, choice (A), may be used to maintain catheter patency, but is now seldom utilized; leveling of the transducer, choice (B), is used to ensure accuracy of the pressures obtained; zeroing the transducer, choice (C), eliminates the effects of atmospheric pressure on the physiologic pressure What laboratory test is most specific for the confirmation of disseminated intravascular coagulation (DIC)? A) D-dimerB) Factor X C) PTT D) FSP - A) D-dimer The patient has acute renal failure with fluid overload, and continuous renal replacement therapy (CRRT) has been ordered. Which of the following would indicate the need for CRRT rather than intermittent hemodialysis? A) hyperkalemia B) MAP 45 mmHg C) Acidosis D) Severe hypoxemia - B) MAP 45 mmHg Cardiogenic shock secondary to left ventricular failure will generally result in: A) Decreased afterload B) Narrow Pulse Pressure C) Decreased Preload D) Widening Pulse Pressure - B) Narrow pulse pressure Pulmonary hypertension may result in which of the following? A) Left HF B) Right HF C) Increased lung compliance D) Arterial hypertension - B) Right HF The patient with diastolic heart failure develops supraventricular tachycardia, heart rate 220/min. The most dangerous hemodynamic effect is a decrease in: A) Myocardial contractility B) Coronary Artery perfusionC) Ejection fraction D) Arterial oxygenation - B) Coronary artery perfusion The 75-year-old patient develops frequent 6 to 10 second episodes of asystole, interspersed with normal sinus rhythm that is associated with hypotension. The priority intervention is: A) Transcutaneous pacing B) Fluid bolus C) Transvenous pacing D) Vasopressors - A) Transcutaneous pacing Which of the following are appropriate interventions for the treatment of anaphylaxis? A) Vasopressors, inotropes, fluids B) Epi SQ, antihistamines, Beta 1 blockers C) Vasopressors, fluids, antibiotics D) Epi IM, Antihistamines, Corticosteroids - D) Epi IM, Antihistamines, Corticosteroids The patient has a right, mid and lower lobe pneumonia. Which of the following is an appropriate intervention for the patient? A) Provide fluids and expectorants B) Maintain in supine positions C) Hold enteral nutrition D) Avoid turning to the right side - D) Avoid turning to the right side Gravity will increase perfusion to the dependent lung tissue. The "good" lung in this case is the LEFT side. Turning the patient to the right may precipitate hypoxemia by increasing perfusion to the side with greater disease. The patient presents with hypotension refractory to initial treatment, and a pulmonary artery catheter is placed. The hemodynamic profile demonstrates right atrial (RA) pressure 1 mmHg, pulmonary artery pressure (PAP) 19/6 mmHg, pulmonary artery occlusive pressure (PAOP) 4 mmHg, systemic vascularresistance (SVR) 1500dynes/sec/cm5, and SvO2 55%. What is most likely the cause of the patient's hypotension and treatment? A) Hypovolemic shock, fluids B) Septic shock, vasopressors C) Cardiogenic shock, IABP D) Anaphylactic shock, epi IM - A) Hypovolemic shock, fluids Volume depletion results in a decreased preload. Compensatory response to volume depletion results in an increase in SVR in an attempt to maintain pressure. Fluids will restore filling pressure (preload) and the SVR will return to normal as compensatory mechanisms will no longer be needed. The patient is receiving heparin therapy and has a PTT of 180 seconds. Which of the following is indicated? A) Heparin B) Protamine sulfate C) Vitamin K D) Platelets - B) Protamine sulfate Protamine is the reversal agent for heparin. Heparin (A) is not the treatment, it will increase the PTT further; Vitamin K (C) is the reversal agent for warfarin, not heparin; platelets (D) are used to address thrombocytopenia. One effect of a dobutamine (Dobutrex) infusion includes: A) A decrease in HR B) An increase in Afterload C) A decrease in contractility D) An increase in myocardial oxygen demand - D) An increase in myocardial oxygen demandDobutamine stimulates beta I receptors in the heart and increases contractility. This stimulation, while helpful for decreased contractility, also results in an increase in myocardial oxygen demand and work (and possible arrhythmias). The patient presents with a Stage III pressure wound with purulent drainage. Temperature is 39.4° C, B/P 82/38 mmHg, heart rate 130/min, hemoglobin 9.1 gm/dL, WBC 3,000 and bands 25%. A total of 1500 mL isotonic solution was infused and a central venous catheter was inserted. Currently the CVP is 4 mmHg, B/P 80/40 mmHg and heart rate 122/min. Which of the following assessments/interventions is appropriate? A) The patient has severe sepsis; continue fluid at 50 ml/hr until the MAP is 65 mmHg B) The patient has septic shock; begin norepinephrine C) The patient has sepsis; continue fluid boluses until the CVP is 8 mmHg D) Discontinue isotonic fluid, begin 0.45 NS at 50 mL/hour, begin a phenylephrine infusion - B) The patient has septic shock; begin norepinephrine The clinical signs are those of a patient with an infection, organ dysfunction, and hypotension despite fluids; therefore, the patient has septic shock and requires pressors to restore vascular tone. The patient presents with hypotension refractory to initial treatment, and a pulmonary artery catheter was placed. The hemodynamic profile demonstrated right atrial (RA) pressure 10 mmHg, pulmonary artery pressure (PAP) 49/25 mmHg, pulmonary artery occlusive pressure (PAOP) 24 mmHg, systemic vascular resistance (SVR) 1900 dynes/sec/cm5, and SvO2 48%. What is most likely the cause and treatment of the patient's hypotension? A) Hypovolemic shock; fluids B) Septic shock; vasopressors C) Cardiogenic shock; IABP D) Anaphylactic shock; epinephrine IM - C) Cardiogenic shock; IABP Pump failure decreases contractility, prevents normal ejection, and results in elevated left heart pressure. Compensatory response to the decrease in contractility, cardiac output, results in vasoconstriction and elevated afterload, although the compensatory responses fail to maintain the blood pressure. Due to the low cardiac output, the mixed venous oxygen saturation (SvO2) is decreased.Which of the following is most likely to result in a low SvO2? A) Hypothermia B) Severe sepsis C) Fever D) Neuromuscular blocking agent - C) Fever Fever increases metabolic rate and oxygen consumption, which may lead to a drop in mixed venous oxygen saturation. The remaining choices may increase the SvO2 since they are associated with a decrease in oxygen utilization.