Which complication does the nurse recognize as a risk for a patient during insertion and removal of a Swan-Ganz catheter?

Decrease in cardiac output

Damage to the mitral valve

Myocardial infarction

Ventricular dysrhythmias

Answer and Explanation

The Correct Answer is D

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.

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Correct Answer is A

Explanation

A. Begin cardiopulmonary resuscitation: Asystole indicates a complete absence of ventricular electrical activity, and the patient is pulseless and apneic. Immediate initiation of high-quality CPR is critical to maintain circulation and oxygen delivery to vital organs while advanced resuscitative measures are prepared. Early CPR improves the chance of return of spontaneous circulation.

B. Prepare to defibrillate: Defibrillation is effective for shockable rhythms such as ventricular fibrillation or pulseless ventricular tachycardia. Asystole is a non-shockable rhythm, so defibrillation would not restore cardiac activity and would delay essential CPR.

C. Begin rescue breathing with bag-valve-mask: While providing oxygenation is important, in a pulseless patient, chest compressions take priority over rescue breathing. CPR ensures perfusion of the brain and heart until advanced life support interventions can be applied.

D. Prepare to cardiovert: Synchronized cardioversion is indicated for unstable tachyarrhythmias such as atrial fibrillation or supraventricular tachycardia. It is not appropriate for asystole, which requires immediate CPR and administration of medications such as epinephrine under advanced life support protocols.

A. Urine volume B. Blood urea nitrogen (BUN) level C. Glomerular filtration rate (GFR) D. Potassium level

Correct Answer is C

Explanation

A. Urine volume: Monitoring urine output provides a rough estimate of kidney function and fluid balance. However, urine volume alone may be misleading in AKI, as patients can have non-oliguric AKI with normal or high urine output despite poor filtration, making it insufficient to evaluate true improvement in kidney function.

B. Blood urea nitrogen (BUN) level: BUN reflects nitrogenous waste accumulation and can indicate impaired renal function. However, it is influenced by factors such as dehydration, high-protein diet, and catabolism, limiting its reliability as the sole marker of kidney recovery.

C. Glomerular filtration rate (GFR): GFR directly measures the kidneys’ ability to filter blood and excrete waste. An increasing GFR indicates improving renal function, making it the most accurate and useful parameter to assess recovery from AKI. Trends in GFR provide a comprehensive picture of kidney performance beyond urine output or single lab values.

D. Potassium level: Hyperkalemia is a common complication of AKI, reflecting impaired excretion. While potassium monitoring is critical for patient safety, changes in potassium alone do not reliably indicate overall improvement in kidney function, as levels can be influenced by medications, diet, and cellular shifts

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