The nurse is caring for a patient with a pulmonary artery catheter. The nurse assesses the pressure monitoring system and would immediately correct which finding?
The pressure bag is inflated to 100mmHg.
Normal saline is used for the flush bag.
The transducer is zeroed with good waveform noted.
The connections are secure.
The Correct Answer is A
Choice A rationale
The pressure bag must be maintained at 300 mmHg to ensure a continuous flush of approximately 3 mL per hour through the system. This high pressure is necessary to overcome the patient’s arterial or pulmonary artery pressure and keep the catheter patent. If the bag is only at 100 mmHg, blood may back up into the tubing, causing clots and inaccurate readings. The nurse must immediately increase the pressure to prevent equipment failure and maintain accuracy.
Choice B rationale
Normal saline is the standard and appropriate fluid used for the flush bag in a hemodynamic monitoring system. It is isotonic and compatible with the patient’s blood, making it the safest choice for maintaining the patency of the invasive line. Since this is a correct and expected finding, the nurse would not need to correct it. Using other fluids, like hypotonic solutions, would be incorrect and could lead to hemolysis or other physiological complications.
Choice C rationale
Zeroing the transducer is a mandatory step to ensure that the monitor ignores atmospheric pressure and only measures the patient’s internal pressures. A good waveform indicates that the system is properly placed and functioning without dampening or interference. This finding represents a correctly set up system that is providing reliable data for clinical decision-making. Therefore, no corrective action is required by the nurse for this specific part of the assessment.
Choice D rationale
Secure connections are vital in any invasive pressure monitoring system to prevent accidental exsanguination or the entry of air into the vascular system. Loose connections can also cause air bubbles, which lead to dampened waveforms and inaccurate pressure readings. Because the connections are noted to be secure, the system is safe and functioning as intended. This is an ideal finding that requires no intervention from the nursing staff to rectify.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice B rationale
Third-degree or complete heart block occurs when there is a total dissociation between the atria and the ventricles. No atrial impulses reach the ventricles, resulting in independent pacing of both chambers. Because the ventricular escape rhythm is typically slow (20 to 40 beats per minute) and unreliable, it cannot maintain adequate cardiac output. A permanent pacemaker is the definitive treatment to provide a reliable heart rate and restore synchronized electrical activity, preventing syncope or cardiac arrest.
Choice A rationale
This medication is a calcium channel blocker used primarily to slow the ventricular rate in rhythms like atrial fibrillation or supraventricular tachycardia by delaying conduction through the AV node. In third-degree heart block, the AV node is already non-functional or completely blocked. Administering a drug that further slows AV conduction or suppresses escape rhythms would be dangerous and could lead to ventricular asystole. It is contraindicated in this setting where the heart rate is already critically low.
Choice C rationale
Third-degree heart block is the highest degree of block and represents a medical emergency due to the risk of profound bradycardia and low cardiac output. Monitoring or observation is inappropriate because the patient is at high risk for sudden cardiac death. Immediate intervention with transcutaneous pacing is required as a bridge until a permanent pacemaker can be placed. Waiting for further progression is not a clinical option as there is no higher degree of block to observe.
Choice D rationale
This is a Class 1A antiarrhythmic used to treat ventricular arrhythmias and certain supraventricular tachycardias by slowing conduction velocity. Like other antiarrhythmics, it can further suppress the heart's natural escape rhythms. In the presence of a complete heart block, where the patient relies on a slow ventricular escape rhythm to survive, this medication could eliminate that remaining heartbeat entirely. It is not indicated for the treatment of bradycardias or AV blocks and would be harmful.
Correct Answer is D
Explanation
Choice A rationale
Flushing with saline before administration is correct to ensure line patency, but giving a potent medication like digoxin as a rapid push is unsafe. Digoxin is a cardiac glycoside that increases the force of myocardial contraction and slows the heart rate. Normal serum levels are 0.5 to 2.0 ng/mL. Rapid administration can cause intense vasoconstriction and cardiac arrhythmias. It must be delivered slowly to allow the medication to distribute and to monitor the heart's response.
Choice B rationale
Administering the medication first without ensuring the line is patent is poor practice. More importantly, waiting five minutes before flushing does not address the need for a slow, controlled delivery of the drug. Digoxin must be administered slowly over at least five minutes to prevent toxic peaks and to mitigate the risk of bradycardia or heart block. Flushing after the medication is necessary to ensure the entire dose is delivered from the IV tubing into the bloodstream.
Choice C rationale
Injecting intravenous push medications into a primary IV bag is generally incorrect for drugs intended for rapid but controlled delivery. This dilutes the medication significantly and changes the rate of delivery to whatever the primary infusion rate is set to, rather than the intended five minute duration. Digoxin should be given as a slow direct injection or via a secondary "piggyback" if specified, but the standard protocol for IVP digoxin is slow manual administration over several minutes.
Choice D rationale
The safest method for administering digoxin IVP is to inject it slowly in small increments over a period of at least five minutes. This slow delivery minimizes the risk of sudden cardiac toxicity and allows the nurse to monitor the patient for adverse effects like significant bradycardia. Following the medication with a saline flush ensures the full dose reaches the patient. This controlled approach is vital because digoxin has a narrow therapeutic index and potent effects on cardiac conduction.
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