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A client had coronary artery bypass graft (CABG) surgery. His hemodynamics are:

  • central venous pressure (CVP) low at 1 mm Hg;
  • pulmonary artery pressure (PAP) low at 20/4 mm Hg;
  • cardiac output (CO) low at 4 L/min;
  • systemic vascular resistance (SVR) high at 1600 dynes/sec/cm(-5):
  • BP low at 90/56 mm Hg.

The client's hemodynamic status would benefit most from

A.

dopamine.

B.

fluid replacement.

C.

nitroprusside sodium.

D.

furosemide.

Answer and Explanation

The Correct Answer is B

A. Dopamine can increase cardiac output and BP but may worsen hypovolemia if the patient is volume-depleted.
B. Low CVP and PAP indicate hypovolemia; fluid replacement is the priority to restore preload, improve cardiac output, and stabilize blood pressure.
C. Nitroprusside sodium is a vasodilator and would further lower BP, which is contraindicated in this hypotensive, hypovolemic patient.
D. Furosemide is a diuretic and would worsen hypotension and low preload; it is not appropriate in this situation.


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Related Questions

Correct Answer is B

Explanation

A. White blood cell differential is important for infection monitoring but is not a primary concern in cardiomyopathy.
B. BUN reflects renal perfusion and function, which can be compromised in cardiomyopathy due to decreased cardiac output. Monitoring BUN helps detect early signs of renal impairment from poor cardiac output.
C. Sodium levels are important but less immediately indicative of cardiomyopathy complications than renal function.
D. Liver function tests (ALT, AST, bilirubin) can be affected in severe heart failure, but renal function is typically prioritized first in acute cardiomyopathy management.

Correct Answer is D

Explanation

A. Pulmonary Vascular Resistance (PVR) reflects the afterload of the right ventricle, not the left ventricle.
B. Central Venous Pressure (CVP) indicates right atrial pressure and preload, not afterload.
C. Pulmonary Capillary Wedge Pressure (PCWP) reflects left ventricular preload, not afterload.
D. Systemic Vascular Resistance (SVR) represents the resistance the left ventricle must overcome to eject blood into the systemic circulation, making it the primary measure of left ventricular afterload.

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