Teaching for a new staff nurse has been effective when the new nurse performs which action while caring for a patient with hemodynamic monitoring?

Ensures that the patient must be lying supine with the head of the bed flat for all readings.

Positions the limb with the catheter insertion site at zero reference of the stopcock line.

Positions the zero-reference stopcock level with the phlebostatic axis.

Balances and calibrates the hemodynamic monitoring equipment every hour.

Answer and Explanation

The Correct Answer is C

A. Ensures that the patient must be lying supine with the head of the bed flat for all readings: While patient positioning can affect hemodynamic measurements, it is not necessary for the patient to remain completely supine. The head of the bed can often be elevated up to 45 degrees without significantly altering readings if zeroing is done correctly at the phlebostatic axis.

B. Positions the limb with the catheter insertion site at zero reference of the stopcock line: Positioning the limb alone does not ensure accurate hemodynamic readings. Pressure transducers must be leveled relative to a standard anatomic reference (the phlebostatic axis) to account for hydrostatic pressure differences, regardless of limb placement.

C. Positions the zero-reference stopcock level with the phlebostatic axis: The phlebostatic axis (approximately at the fourth intercostal space, mid-axillary line) represents the level of the right atrium and serves as the reference point for accurate hemodynamic pressure measurements. Correct leveling ensures that readings of central venous pressure, arterial pressure, or pulmonary artery pressure accurately reflect the patient’s intravascular pressures.

D. Balances and calibrates the hemodynamic monitoring equipment every hour: Hemodynamic monitoring equipment is typically zeroed and calibrated at setup and when clinically indicated (e.g., after repositioning, line flushing, or pressure waveform changes). Hourly recalibration is unnecessary and does not substitute for correct leveling at the phlebostatic axis.

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Correct Answer is D

Explanation

A. Decrease in cardiac output: A Swan-Ganz (pulmonary artery) catheter rarely causes an immediate decrease in cardiac output unless complications like arrhythmias or pulmonary artery rupture occur. Monitoring hemodynamics helps detect changes, but this is not the most common risk during insertion or removal.

B. Damage to the mitral valve: The catheter passes through the right atrium and right ventricle into the pulmonary artery, so the mitral valve is not in the pathway. Injury to the mitral valve is unlikely, making this a low-risk complication.

C. Myocardial infarction: Myocardial infarction is not a typical complication of Swan-Ganz catheterization unless coronary perfusion is severely compromised by another underlying condition. It is not directly caused by the catheter itself.

D. Ventricular dysrhythmias: As the catheter passes through the right ventricle, it can mechanically irritate the ventricular myocardium, leading to premature ventricular contractions, ventricular tachycardia, or other dysrhythmias. This is the most common and expected complication during insertion and removal, requiring continuous ECG monitoring.

A. Syndrome of inappropriate secretions of antidiuretic hormone (SIADH) B. Disseminated intravascular coagulation (DIC) C. Pericardial effusion/tamponade (PE/T) D. Superior vena cava syndrome (SVC)

Correct Answer is D

Explanation

A. Syndrome of inappropriate secretions of antidiuretic hormone (SIADH): SIADH is characterized by water retention, hyponatremia, and low serum osmolality. While it can occur in cancer patients, it does not typically cause facial and neck swelling or distended chest veins, making it unlikely in this scenario.

B. Disseminated intravascular coagulation (DIC): DIC is a systemic coagulopathy leading to both thrombosis and bleeding. Clinical manifestations include petechiae, ecchymoses, and bleeding, not venous distention or facial edema. DIC does not explain the localized obstruction of venous return.

C. Pericardial effusion/tamponade (PE/T): Cardiac tamponade causes jugular venous distention, hypotension, and muffled heart sounds (Beck’s triad). While there may be venous congestion, the edema is usually generalized, not limited to the face, neck, and upper chest, and periorbital edema is less typical.

D. Superior vena cava syndrome (SVC): SVC syndrome results from obstruction of the superior vena cava, often due to malignancy compressing the vessel. This obstruction impairs venous return from the head, neck, and upper extremities, leading to facial and periorbital edema, neck swelling, and distended chest veins. It is an oncologic emergency requiring prompt recognition and intervention.

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Teaching for a new staff nurse has been effective when the new nurse performs which action while caring for a patient with hemodynamic monitoring?

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Naxlex Comprehensive Predictor Exams

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Explanation

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Correct Answer is D

Explanation

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