The nurse admits a patient to the ICU with a gastrointestinal bleed and a week long history of vomiting and diarrhea. The patient has a Pulmonary Artery (PA) catheter in place. A fluid bolus is initiated to treat which underlying issue?
Decreased preload.
Decreased afterload.
Increased preload.
Increased afterload.
The Correct Answer is A
Choice A rationale
Preload refers to the degree of stretch of the cardiac myocytes at the end of diastole, which is directly related to the volume of blood in the ventricles. In a patient with significant fluid loss from vomiting, diarrhea, and gastrointestinal bleeding, the intravascular volume is severely depleted. This leads to decreased venous return and low preload. Administering a fluid bolus increases the circulating volume, thereby improving preload and subsequent cardiac output.
Choice B rationale
Afterload represents the resistance the heart must pump against to eject blood into the systemic circulation. While systemic vascular resistance may increase as a compensatory mechanism in hypovolemia, a fluid bolus is not primarily intended to decrease afterload. In fact, increasing volume does not directly lower the resistance of the vessels. The primary goal in a bleeding and dehydrated patient is to restore the volume that contributes to the initial filling of the heart.
Choice C rationale
Increased preload is the desired result of the fluid bolus, not the underlying issue being treated. The patient currently suffers from a lack of volume, so their preload is low. If the preload were already increased, as seen in fluid overload or congestive heart failure, a fluid bolus would be contraindicated as it would worsen pulmonary edema and cardiac strain. The clinician uses the pulmonary artery catheter to confirm that low pressures indicate a need for volume.
Choice D rationale
Increased afterload occurs when the blood vessels are constricted, making it harder for the heart to pump. This is common in hypertensive crises or as a late response to shock. However, this patient has lost fluids and blood, which naturally points to a volume deficit. Treating increased afterload would involve vasodilators, not a fluid bolus. The clinical history of gastrointestinal loss clearly identifies a volume deficit as the primary pathological state requiring immediate fluid resuscitation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Synchronized cardioversion requires the machine to sense the QRS complex specifically. If the discharge occurs during the P wave, it would not successfully terminate the tachyarrhythmia. The P wave represents atrial depolarization, but the goal is to safely reset the ventricular rhythm. Incorrectly timing the shock could lead to ineffective therapy or trigger more dangerous rhythms if the electrical discharge happens during the wrong phase of cardiac activity.
Choice B rationale
Defibrillation at 360 joules is an unsynchronized high energy shock used for pulseless rhythms like ventricular fibrillation or pulseless ventricular tachycardia. Using this for a patient with supraventricular tachycardia who still has a pulse and blood pressure, even if low, is inappropriate. An unsynchronized shock delivered during the vulnerable period of the T wave could actually induce ventricular fibrillation, worsening the patient's critical condition and leading to immediate cardiac arrest.
Choice C rationale
Defibrillation at 100 joules is also an unsynchronized delivery of electrical energy. While the energy level is lower than 360 joules, the lack of synchronization remains the primary safety concern. Patients in supraventricular tachycardia with signs of hemodynamic instability, such as a blood pressure of 80/40 and chest pain, require synchronized cardioversion to avoid the R on T phenomenon. Unsynchronized shocks are strictly reserved for patients who lack a discernible pulse or rhythm.
Choice D rationale
Selecting sync ensures the defibrillator delivers the electrical shock exactly on the R wave, which is the peak of ventricular depolarization. This timing avoids the vulnerable repolarization period of the T wave. For a patient with supraventricular tachycardia and hypotension, synchronization is vital to prevent inducing ventricular fibrillation. This precise timing allows the heart to depolarize simultaneously and provides the opportunity for the sinoatrial node to resume its role as the primary pacemaker.
Correct Answer is C
Explanation
Choice A rationale
Administering antianxiety medication is a comfort measure but does not address the immediate physiological risks associated with suctioning. Suctioning induces transient hypoxia and increases myocardial oxygen demand, which can lead to dysrhythmias. While reducing patient distress is important for overall care, it is not the highest priority when compared to maintaining adequate cellular oxygenation during an invasive procedure that actively removes oxygen from the airway.
Choice B rationale
Instilling normal saline into the endotracheal tube was once common practice but is now discouraged because it does not effectively thin secretions. Instead, it can displace bacteria from the inner lumen of the tube deeper into the lower respiratory tract, increasing the risk of ventilator-associated pneumonia. It also decreases oxygen saturation significantly. Hydration and humidification are the preferred systemic methods for managing thick pulmonary secretions in intubated patients.
Choice C rationale
Suctioning removes both secretions and oxygen from the airway, which can lead to severe hypoxemia, bradycardia, or even cardiac arrest. Providing 100 percent FiO2 for at least 30 to 60 seconds prior to the procedure creates an oxygen reserve in the lungs. This prevents the hemoglobin saturation from dropping to dangerous levels during the periods of apnea and negative pressure. This action is the highest priority to ensure patient safety.
Choice D rationale
Auscultation is a necessary assessment to evaluate the effectiveness of the suctioning procedure and to ensure the airway is clear. However, it is an evaluative step performed after the intervention has occurred. While it helps determine if further suctioning is required, it does not prevent the immediate life-threatening complications of hypoxia that occur during the procedure itself. Therefore, it remains secondary to the proactive step of pre-oxygenation.
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