Hoffman Chapter 32 Coordinating Care for Critically Ill Patients with Cardiovascular Dysfunction

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Dysfunction Study online at https://quizlet.com/ cw6y9d In setting up hemodynamic monitoring equipment, the nurse cor- relates which action as the rationale for zeroing the transducer? 1. Preventing air from entering the system 2. Offsetting atmospheric pressure that may alter the reading 3. Minimizing the risk of infection 4. Providing pressure in the system The nurse conducts an Allen test for a patient who requires the placement of an arterial line. Which finding indicates a positive test? 1. Normal color returns in 13 seconds 2. Normal color returns in 12 seconds 3. Normal color returns in 11 seconds 4. Normal color returns in 10 seconds The nurse provides care to a patient with an arterial line. Which is the priority nursing action when providing care to this patient? 1. Labeling the line, "No IV medications" 2. Observing the pulse oximetry waveform every shift 3. Flushing the arterial line every hour to prevent clotting 4. Ensuring the site used for the line is covered with an occlusive dressing The nurse wants to evaluate a patient's right heart preload. Which approach should be used to obtain this measurement? 1) Zero the arterial line 2) Measure the central venous pressure 3) Measure the pulmonary artery wedge pressure 4) Attach the proximal infusion port to an intravenous solution The nurse recognizes which clinical manifestation in the patient with right-sided heart failure? 1. Increased central venous pressure 2. Increased left atrial pressure 3. Decreased blood pressure 4. Decreased systemic vascular resistance The nurse correlates which measurement as an indirect measure- ment of cardiac contractility? 1. Central venous pressure 2. Left ventricular stroke index (LVSWI) 3. Mean arterial pressure 4. Systemic vascular resistance The healthcare provider wants an SvO2 level on a patient with a pulmonary artery catheter. The nurse collects this sample from which port of the catheter? 1. Distal lumen port 2. Balloon port 3. Proximal injectable port 4. Proximal infusion port The nurse is preparing to obtain a pulmonary artery occlusive pressure (PAOP) on a patient and implements which action to ensure the patient's safety? 1. Inflating the balloon 1.5 mL 2. Placing the patient in the Trendelenburg position Hoff Ch 32 Coordinating Care for Critically lll Patients with Cardiovascul: 2. The transducer must be routinely calibrated, commonly referred to as "zeroing," to offset the atmospheric and hydrostatic pressures that may alter the reading. 4. Normal color returns in 7 to 10 seconds in a positive test. 1. Arterial lines should be clearly marked so that intravenous (V) medications are not given via this route. Inadvertent intra-arterial IV infusion can lead to tissue necrosis, gangrene, and loss of limb. 2. Measuring the central venous pressure is a reflection of right heart preload. 1. An elevated central venous pressure (CVP) may indicate in- creased volume that may occur with right-sided heart failure. CVP may also be elevated when intrathoracic pressures or pressures in the pulmonary circuit are increased, requiring pressure in the right side of the heart to increase to facilitate flow. 2. The pulmonary artery (PA) catheter allows for indirect measure- ment of contractility via left ventricular stroke work index (LVSWI), and right ventricular stroke work index (RVSWI). 1. Oxygen utilization at the tissue level can be indirectly measured by evaluating an SvO2 level, a blood sample obtained via the distal port of the pulmonary artery catheter. 1. When a pulmonary artery occlusive pressure (PAOP) is obtained, the balloon must be inflated no more than 1.5 mL.

Hoff Ch 32 Coordinating Care for Critically lll Patients with Cardiovascul: Dysfunction Study online at https://quizlet.com/ cw6y9d 3. Manually deflating the balloon 4. Deflating the balloon within 5 minutes of obtaining the pressure The nurse correlates damage to which area of the heart in the patient who has complete occlusion of the left anterior descending (LAD) artery? 1. 1. Anterior wall An anterior wall myocardial infarction (Ml) is associated with oc- 2. Inferior wall clusion in the left anterior descending artery. 3. Lateral wall 4. Posterior wall The nurse correlates electrocardiogram (ECG) lead changes in leads I, Ill, and aVF to which type of myocardial infarction? 2 1. Ante_rior wal ECG changes in Leads l, lll, aVF are associated with inferior wall 2. Inferior wall 3. Lateral wall myocardial infarctions. 4. Posterior wall A patient is being evaluated for chest pain in the emergency department. Which laboratory test is the best to determine if this patient has experienced an acute myocardial infarction? Cardiac troponin (I and T) are proteins expressed almost exclu- sively in the heart and are a specific marker of cardiac muscle damage. It can elevate within 4 hours of injury and can stay elevat- ed for up to 10 days. Because it stays elevated longer than creatine kinase MB (CK-MB), it is a valuable marker when attempting to diagnose injury in the recent past. Troponin is the blood test of choice to diagnose acute myocardial infarction (AMI). 1. Troponin 2. Creatine kinase 3. Creatine kinase MB 4. Serum lactate level The nurse provides instructions to a patient who is being dis- charged after treatment for a myocardial infarction. Which patient statement indicates a need for additional teaching? 4. 1. "l will take the Lipitor to reduce my cholesterol levels." 2."| will take the Lopressor to decrease my heart's demand for Sublingual nitroglycerin is taken as needed for chest pain, not oxygen." each day. This patient statement indicates a need for additional 3. "l will take the Plavix to prevent the platelets from forming new teaching. clots.” 4. "l will take the sublingual nitroglycerin each day to prevent chest pain." The nurse correlates damage to which area of the heart in patients 1 who experience an inferior wall myocardial infarction (Ml)? ' 1. Sinoatrial (SA) node Asystole, symptomatic bradycardia, and heart block are usually associated with sinoatrial (SA) node dysfunction. This is most common after an inferior myocardial infarction (Ml) because the right coronary artery supplies the SA node. 2. Atrioventricular (AV) node 3. Purkinje fibers 4. Ventricles The nurse is preparing medications for a patient experiencing an acute myocardial infarction. Which medication will dilate the patient's coronary blood vessels? 3 1. Heparin 2. Fibrinolytics 3. Nitroglycerin 4. Beta blockers Nitroglycerin dilates the coronary arteries. The nurse instructs a patient recovering from an acute myocardial 3. infarction on the Life's Simple 7 actions. Which patient statement indicates that additional teaching is required? Exercise for at least 150 minutes of moderate-intensity activity, or 75 minutes of vigorous-intensity activity, or a combination of each 1. "l will not smoke." per week is one of the American Heart Association's Life Simple 2."| will eat a heart-healthy diet." 7 strategies. 2/7

Dysfunction Study online at https://quizlet.com/ cw6y9d 3. "l will walk for at least 30 minutes three times a week." 4."| will make sure my blood sugar level stays under 100 mg/dL." The nurse is reviewing medications prescribed for a patient with hypertrophic cardiomyopathy. Which medication does the nurse question as a primary treatment for this condition? 1. Angiotensin-converting enzyme inhibitor (ACE-I) 2. Diuretic 3. Digoxin 4. Beta blocker In administering an angiotensin-converting enzyme inhibitor to a patient with cardiomyopathy, the nurse correlates which rationale for this medication? 1. Reduce afterload 2. Improve heart muscle contractions 3. Reduce fluid accumulation in the lungs 4. Decrease sympathetic response to decreased cardiac output The nurse monitors for which hemodynamic parameter in the patient with cardiogenic shock? 1. Increased afterload 2. Increased venous oxygen saturation 3. Increased cardiac output 4. Increased mean arterial pressure The nurse correlates which arterial blood gas results to compen- sated metabolic acidosis in the patient with cardiogenic shock? 1.pH 7.30 / PaCO2 38 mm Hg / HCO3 18 mEq/L 2.pH 7.38 / PaC0O2 32 mm Hg / HCO3 20 mEq/L 3.pH 7.40 / PaCO2 40 mm Hg / HCO3 23 mEq/L 4. pH 7.48 / PaC0O2 40 mm Hg / HCO3 28 mEq/L The nurse correlates which rationale to the administration of pos- itive inotropic medications to a patient in cardiogenic shock? 1. Increase heart rate 2. Increase cardiac contractility 3. Decrease venous return 4. Decrease systemic vascular resistance The nurse is caring for a patient experiencing cardiogenic shock. Which medication should the nurse expect to be prescribed to improve this patient's cardiac output? 1. Nitroglycerin 2. Morphine sulfate 3. Norepinephrine (Levophed) 4. Dobutamine hydrochloride (Dobutamine) In administering nitroglycerin to the patient in cardiogenic shock, the nurse recognizes which of the following as the rationale? 1. Increases heart rate 2. Increases systemic vascular resistance 3. Decreases cardiac contractility 4. Decreases afterload The health-care provider wants to determine a patient's cardiac contractility. What should be used to make this determination? 1) Cardiac output Hoff Ch 32 Coordinating Care for Critically lll Patients with Cardiovascul: 3. Digoxin, a positive inotrope agent, is not indicated for primary therapy but may be used to control symptoms such as fatigue, dyspnea, and exercise intolerance. 1. Angiotensin-converting enzyme inhibitors reduce afterload, mak- ing it easier for the heart to eject blood. 1. Sympathetic stimulation causes vasoconstriction to maintain sys- temic blood pressure in an effort to increase cardiac output (CO), which also increases systemic vascular resistance (afterload). 2. This ABG result indicates compensated metabolic acidosis. The HCQO3 is low (acidotic), but the pH is within normal limits and the HCQO3 is low, indicating respiratory compensation 2. Positive inotropic medications improve the heart muscle contrac- tions, reducing associated heart failure symptoms. 4. Inotropic medications such as dobutamine hydrochloride (Dobut- amine) improve cardiac output. 4. Nitroglycerin is used in cardiogenic shock to decrease preload and afterload. It decreases preload through venous dilation and decreases afterload through arterial dilation. Contractility is the inherent ability of the heart muscle to contract independently of preload and afterload. Contractility cannot be directly measured but can be inferred by evaluating stroke work 3/7

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