cvp readingapatin, ronick allan d.

Pre Test

1. the pressure within the right atrium and in the great vein within the thoraxa. central venous pressureb. bood pressurec. right atrial pressured. both a and c

answer: drationale: CVP represents the filling pressure of the right ventricle and it indicates the ability of the right side of the heart to manage a fluid load

2. it is the reference point where the zero mark of the manometer must be placed during cvp readinga. phlebostatic axisb. mcburney's pointc. both a and bd. none of the above

answer: arationale: McBurney's point is the name given to the point over the right side of the abdomen that is one-third of the distance from the anterior superior iliac spine to the umbilicus (navel). This point roughly corresponds to the most common location of the base of the appendix where it is attached to the cecumPhlebostatic axisthe approximate location of the right atrium, found at the intersection of the midaxillary and a line drawn from the fourth intercostal space at the right side of the sternum. The phlebostatic axis is used extensively in hemodynamics

3. what is the normal range of central venous pressure?a. 5 - 12b. 7 - 15 c. 8 - 20d. 10 - 15

answer: arationale: the change in CVP is a more useful indication of adequacy of venous blood volume and alterations of cardiovascular function. CVP is a dynamic measurement. The normal values may change from patient to patient. The management of the patients not based on one reading but on repeated serial readings in correlation with patients clinical status.

4. unit being used in cvp reading a. cmH2Ob. mmH2Oc. mmHgd. none of the above

answer: a

Post Test

5. common complication of cvp monitoringa. infectionb. air embolismc. both a and b

answer: crationale: break in the skin during incisionair may be introduced when catheter is disconnected from iv line

6. When a nurse is measuring central venous pressure (CVP) by manometer, which of the following is the correct position for accurately obtaining a measurement? [Hint] a. Client supine, head of bed elevated, measure at the 4th intercostal space on lateral chest wall b. Client supine, head of bed flat, measure at the site of the central venous catheter c. Client supine, head of bed flat, measure at the 4th intercostal space on lateral chest wall d. Client supine, head of bed elevated, measure at the site of the central venous catheter

answer: crationale: the appropriate positioning for accurately measuring central venous pressure is supine with head of bed flat. Measure at the 4th intercostal space on the lateral chest wall midway between the anterior and posterior chest. The site should be marked as a reference point for future measurements

7. What jugular vein is most often preferred for cannulation for central venous pressure (CVP)? a. right internal jugularb. left internal jugularc. subclavian d. none of the above

answer: arationale: Left-sided catheterization via the left jugular vein increases the risk of (1) vascular erosion, (2) pleural effusions, and (3) puncture of the thoracic duct, leading to chylothorax

8. all but one cause decreased cvp readinga. hypovolemiab. hypervolemiac. deep inhalationd. none of the above

answer: brationale: hypovlolemia and deep inhalation cause decreased cvp reading

9. which of the following causes increased cvp reading?a. distributive shockb. Mechanical ventilation and the application of positive end-expiratory pressure (PEEP),Pulmonary c. hypovolemiad. deep inhalation

answer: brationale: choices a, c and d cause decreased cvp reading

10. site where cvp catheter is inserteda. anticubital siteb. femoral arteryc. subclavian artery

answer: anticubital siterationale: front of elbow ( smaller vein, less bleeding or uncontrollable bleeding in cases of coagulopathy,thromoltic therapy, anticoagulation therapy)

11. What are the indications for central venous cannulation? a. Administrationof fluid and electrolytesb. Drug Therapyc. Venous access for monitoring Central Venous Pressured. Venous access for insertion of a pulmonary artery cathetere. all of the above

answer: erationale: all are possible indication for cvp insertion

12. contraindications for cvp insertiona. parenteral nutritionb. thrombolytic therapyc. both a and cd. none of the above

answer: brationale: may cause uncontrolled bleeding

13. What is the nurse's primary concern regarding fluid & electrolytes when caring for an elderly pt. who is intermittently confused? a. risk of dehydration b. risk of kidney damage c. risk of stroke d. risk of bleeding

Answer: aRationale: As an adult ages, the thirst mechanism declines. Adding this in a pt with an altered level of consciousness, there is an increased risk of dehydration & high serum osmolality

14. When caring for a group of pts, the nurse realizes that which of the following health problems increases the risk for metabolic alkalosis? a. bulimia b. dialysis c. venous stasis ulcer d. COPD

Answer: aRationale: Metabolic alkalosis is cause by vomiting, diuretic therapy or nasogastric suction, among others. A pt with bulimia may engage in vomiting or indiscriminate use of diuretics

15. The nurse assesses a pt's weight loss as being 22 lbs. How many liters of fluid did this pt. lose?a.14b.13c.12d.10

Answer: dRationale:Each liter of body fluid weighs 1 kg or 2.2 lbs. This pt has lost 10 liters of fluid.

16. A postoperative pt is diagnosed with fluid volume overload. Which of the following should the nurse assess in this pt? a. poor skin turgor b. decreased urine output c. distended neck veins d. concentrated hemoglobin & hematocrit levels

Answer: cRationale: Circulatory overload causes manifestations such as a full, bounding pulse; distended neck & peripheral veins; increased central venous pressure; cough; dyspnea; orthopnea; rales in the lungs; pulmonary edema; polyuria; ascites; peripheral edema, or if severe, anasarca, in which dilution of plasma by excess fluid causes a decreased hematocrit & blood urea nitrogen (BUN); & possible cerebral edema.

17. a nurse is to administer 10 meqs KCl, how many cc should she aspirate?5mlb. 10mlc. 2mld. 1ml

Answer: arationale: stock dose of KCl: 40meqs/20ml;2meqs/1ml

18. A pt is diagnosed with hyperphosphatemia. The nurse realizes that this pt might also have an imbalance of which of the following electrolytes? a. calcium b. sodium c. potassium d. chloride

Answer: aRationale: Excessive serum phosphate levels cause few specific symptoms. The effects of high serum phosphate levels on nerves & muscles are more likely the result of hypocalcemia that develops secondary to an elevated serum phosphorus level. The phosphate in the serum combines with ionized calcium, & the ionized serum calcium level falls.

19. A pt is admitted for treatment of hypercalcemia. The nurse realizes that this pt's intravenous fluids will most likely be which of the following? a. dextrose 5% & water b. dextrose 5% & ? normal saline c. dextrose 5% & ? normal saline d. normal saline

Answer: dRationale: Isotonic saline is used because sodium excretion is accompanied by calcium excretion through the kidneys

20. A 35-year-old female pt comes into the clinic postoperative parathyroidectomy. Which of the following should the nurse instruct this pt? a. Drink one glass of red wine per day. b. Avoid the sun. c. Milk & milk-based products will ensure an adequate calcium intake. d. Red meat is the protein source of choice.

Answer: cRationale: This pt is at risk for developing hypocalcemia. This risk can be avoided if instructed to ingest milk & milk-based products