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CCRN PEDS Cardiovascular Questions
and Answers.
- Your pediatric patient has the following parameters HR 80 BP 100/ SV 40 BSA 0.9 m The cardiac index (CI) for this patient is A. 4.4 L/min B. 3.2 L/min/m C. 3.5 L/min/m D. 3200 mL/m2 - \C. The cardiac index for this patient is 3.5. First, you must calculate the cardiac output (HR X SV) or (80 X 40 =3200 = 3.2 L/min). Then, use the following equation: (CI = CO/BSA) or (3.2/0.9 = 3.55 L/min/m2) The CI is a more specific indicator of hemodynamic status than cardiac output. The CO has a broader range of 4 to 8 L/min. To make a numbers specific to an individual, the person's body surface area is included in the equation. Then the normal range becomes 2.5-4.0 L/min/m
- Calculate the cardiac output for a 16 year old patient with a heart rate of 72 and a stroke volume of 70 mL A. 55% B. 5.04 L/min C. 504 mL/min D. 1.02 L/min - \B. Normal cardiac output for a 16 year old should be in the range of 4 to 8 L/min. The formula for calculating this value is CO = HR x SV. In this case, 72 (HR) x 70 (SV) = 5040 mL/min. Converted to liters, the answer would equal 5.04 L/min.
- What is the mean arterial pressure for a patient with a blood pressure of 110/50 and a heart rater of 80 A. 80 B. 70 C. 50 D. 60 - \B. The MAP is a mean pressure that takes into account the fact that the diastolic phase represents two-thirds of the cardiac cycle. It is calculated as follows: MAP = (2(DBP) + (SBP))/3. If you took the average of the two pressures only, it would not account for the
importance of the diastolic phase. The HR is not entered into this calculation. Patients should maintain a MAP of at least 60 mmHg to ensure adequate perfusion to the brain and kidneys.
- Which of the following percentages would be considered a normal value for an ejection fraction (EF)? A. 25% B. 35% C. 40% D. 60% - \D. The ejection fraction should be over 50%. This is the amount of blood ejected from the left ventricle compared to the total amount available. This amount is expressed as a percentage. For example, if the ventricle contains 90 mL of blood and 50 mL is ejected, the amount would be represented as a percentage--in this case, 55%. An ejection fraction of 35% or less indicates a problem with contractility, outflow, or filling.
- The ejection fraction (EF) most closely represents which of the following hemodynamic parameters A. RVEDP B. PAOP C. RVP D. LVEDP - \D. The ejection fraction (EF) most closely represents left ventricular end-diastolic pressure (LVEDP). EF and LVEDP are closely related. The LVEDP is the volume of blood under pressure left after the end of contraction.
- Tetralogy of Fallot manifests itself by which of the following combinations of defects? A. VSD, overriding aorta, pulmonary stenosis, and right ventricular hypertrophy B. Aortic stenosis, atrial septal defect, coarctation of the aorta, and PDA C. ASD, mitral prolapse, PDA, and pulmonary stenosis D. Mitral stenosis, PDA, ASD, and coarctation of the aorta - \A. Tetraology of Fallot manifests itself by the following combinations of defects: VSD, overriding aorta, pulmonary stenosis, and right ventricular hypertrophy. This condition results in low oxygenation of blood due to the mixing of oxygenated and deoxygenated blood in the left ventricle via the VSD and mixing of blood from both ventricles through the aorta because of the obstruction to flow through the pulmonary valve. The end result is a left to right shunt. The primary symptom of tetralogy of Fallot is low blood oxygen saturation, with or without cyanosis, from birth or developing in the first year of life. If the baby is not cyanotic, then the condition is sometimes referred to as "pink tet." Other symptoms include a harsh grade II to IV systolic murmur with a thrill, difficulty in feeding, failure ot gain weight, retarded growth, physical development. Polycythemia may be present with dyspnea on exertion, along with clubbing of the fingers and toes.
sometimes called pulmonary capillary wedge pressure (PCWP). The normal value should be in the range of 5-12 mmHg.
- Your patient required placement of a left atrial pressure monitoring line. The pressure reads 18 mmHg. This value might indicate A. Pulmonary embolus B. Pulmonic stenosis C. Tricuspid regurgitation D. Mitral valve dysfunction - \D. A left atrial pressure of 18 mmHg should indicate a mitral valve dysfunction. The mitral valve dysfunction is often seen with a postendocardial cushion repair. The LAP is usually approximately 8 mmHg, so the pressure of 18 mmHg is high. The right atrial pressures would be increased by either pulmonic stenosis or tricuspid regurgitation.
- Which of the following statements is true regarding the fourth heart sound (S4)? A. S4 occurs just after the first heart sound B. The fourth heart sound occurs with ventricular contraction C. The fourth heart sound is benign D. The fourth heart sound is always pathologic after 24 hours of life - \D. The fourth heart sound, S4, is always pathologic after the first 24 hours of life and indicates a decreased ventricular compliance. This heart sound is produced when an atrial contraction fills up the ventricle. S4 is rarely heard in the newborn and occurs just before the S1 heart sound. During the first 24 hours of life, S4 may be heard just after S1 and sounds like a clicking noise.
- The mean pressure difference in the systemic vascular bed divided by blood flow is known as A. LAP B. SVR C. PCW D. PVRI - \B. The mean pressure difference in the systemic vascular bed divided by blood flow is known as systemic vascular resistance (SVR). It indicates the resistance the left ventricle must pump against.
- A heart murmur associated with acute valvular regurgitation is called A. S B. S C. S D. S4 -
\D. A heart murmur associated with acute valvular regurgitation is called S4. S1 and S are normal sounds. S3 is associated with fluid status, S4 is associated with ventricular compliance.
- Stroke volume is comprised of which of the following factors? A. Viscosity, blood volume, and impedance B. Cardiac output, heart rate, and compliance C. Contractility, perload, and afterload D. Systemic impedance, heart rate, and compliance - \C. Stroke volume is comprised of contractility, preload, and afterload. Viscosity, blood volume, and impedance represent the components of afterload. The myocardium is sensitive to changes, especially increased afterload. With only minute changes in afterload, the stroke volume can fall significantly.
- Your patient was admitted for severe dyspnea, dysphagia, palpitations, and an intractable cough. On auscultation, you hear a loud S1 and a right-sided S3 and S4. A pulmonary artery catheter is placed and large A waves are seen in the PAOP tracing. The patient probably has A. Mitral stenosis B. Myocarditis C. Atrial stenosis D. Mitral insufficiency - \A. On a pulmonary catheter tracing, large A waves may be seen with increased pressure during atrial contraction. This pattern could be caused by mitral stenosis, an ischemic left ventricle, or failure of a left ventricle.
- Patrick was admitted to the PICU with aortic insufficiency. During his initial assessment, you note the popliteal BP is higher than the brachial BP by at least 30 mmHg. This phenomenon is known as A. DeRoge's sign B. Hill's sign C. Homes' sign D. Rochelle's sign - \B. A popliteal blood pressure that is at least 20 mmHg higher than the brachial blood pressure is known as Hill's sign. Hill's sign reflects the rapid rise in pulsation found in patients with aortic insufficiency. DeMusset's sign is also found in aortic insufficiency (the bobbing of the head in time with the forceful pulse.)
- Pulsus alternans is most often noted with A. Mitral stenosis B. Constrictive pericarditis C. Left ventricular failure
A. Tall, peaked P waves B. Wide, notched P waves C. Changes in ST segments D. A prolonged Q wave - \B. On an ECG, left-sided heart failure results in wide, notched P waves. Tall, peaked P waves are indicative of right-sided heart failure. Changes in ST segments (or T waves) usually indicate myocardial ischemia
- Your patient has been diagnosed with an AV canal defect. Defects closely associated with this condition would be A. ASD, PDA, ostium primum, a cleft in the anterior mitral valve leaflet, and a VSD in the inlet portion of the ventricle septum B. PDA, a cleft in the anterior mitral valve leaflet, pulmonary stenosis, and a cleft in the spetal leaflet of the tricuspid valve C. ASD, a cleft in the anterior mitral valve leaflet, ostium primum, a VSD in the inlet portion of the ventricle septum, and a cleft in the septal leaflet of the tricuspid valve D. VSD, ostium secundum, mitral stenosis, and a cleft in the septal leaflet of the tricuspid valve - \C. Atrioventricular canal defect is a condition that is often associated with an ostium primum ASD. This defect is also associated with a cleft in the anterior mitral valve leaflet, a VSD in the inlet portion of the ventricle septum, and a cleft in the septal leaflet of the tricuspid valve.
- A moderate-sized ventricular septal defect results in A. A right-to-left shunt B. A left-to-right shunt C. Decreased systemic vascular resistance D. A decrease in pulmonary vascular edema - \B. A moderate-sized ventricular septal defect causes the pulmonary vascular resistance (PVR) to be less than the systemic vascular resistance (SVR). This imbalance will cause a left-to-right shunt. With this condition, too much blood may enter the lungs, increasing edema and possibly preventing or delaying development and maturation of arterioles. A pansystolic murmur can be heard over the left sternal border.
- Bobby, age 3, was admitted to the PICU to help control his increasing tet spells. Tet spells may be treated with which of the following medications A. Dilantin B. Gentamycin C. Morphine D. Digoxin - \C. Tet spells may be treated with morphine to promote venous dilation. IV fluids are used for volume expansion with an increase in systemic BP. If this strategy does not
control the spell, systemic BP can be increased with phyenylephrine or ketamine (both or which have the added benefit of sedation). Propranolol may prevent or mitigate tet spells.
- The resistance against which the right ventricle must eject its volume is known as A. SVR B. PVR C. PAOP D. LVEDP - \B. The resistance against which the right ventricle must eject its volume is known as pulmonary vascular resistance (PVR). PVR is calculated as a mean pressure in the pulmonary vasculature that is divided by the blood flow. Another way to think of it is the pressure against which the right ventricle must pump
- Alpha-adrenergic effects of norepinephrine include A. Increased force of myocardial contraction B. Peripheral arteriolar vasoconstriction C. Increased AV conduction time D. Central venous dilation - \B. Alpha-adrenergic effects of norephinephrine include peripheral arteriolar vasoconstriction. Increased force of myocardial contraction and increased AV conduction time are effeccts of beta-adrenergic sympathetic stimulation.
- While auscultating heart sounds on your new patient, you hear an S3 heart sound. The third heart sound occurs as a result of A. Active atrial contraction B. Aortic stenosis C. Closure of the aortic and pulmonic valves D. Increased blood blow across the AV valves - \D. The third heart sound, S3, occurs when increased blood flow travels across the AV valves secondary to rapid passive ventricular filling from the atria. This is easy to remember if you associate the S3 sound with fluid. It will be prominent in CHF, mitral valve insufficiency, anemia, and left-to-right shunts such as ASD, VSD, and PDA
- Infants with CHF are at high risk during interventional procedures because of A. Transcatheter defect occlusion B. Prolonged testing times C. Balloon atrial septostomy D. Contrast dye - \D. Infants with CHF are at high risk during interventional procedures because of the use of contrast dye. Contrast dye has high sodium content. Sodium contributes to myocardial depression and creates an osmotic effect that temporarily increases
pulmonary venous return, truncus arteriosus, hypoplastic left heart syndrome, and tricuspid valve abnormalities.
- An example of an acyanotic congenital heart defect would be A. Tricuspid stenosis B. Mitral stenosis C. Pulmonary valve stenosis D. Tetralogy of Fallot - \C. Acyanotic congenital heart defects include pulmonary valve stenosis, ventricular septal defect (VSD), atrial septal defect (ASD), patent ductus arteriosus (PDA), aortic valve stenosis, and coarctation of the aorta
- The type of heart murmur commonly heard in patients with tricuspid atresia is A. a diastolic murmur B. a holosystolic murmur C. a systolic murmur D. a pnsystolic murmur - \B. Cardiac murmurs are present in 80% of patients wiht tricuspid atresia. A holosystolic murmur that may have a crescendo and decrescendo quality is heard, suggestive of blood flow through the ventricular septal defect. A continuous murmur may be present. Systemic-to-pulmonary arterial collaterals or arterial-to-pulmonary arterial anastomeses surgically created to improve pulmonary blood flow may cause the finding. A murmur of mitral insufficiency may also be present
- Which of the following hemodynamic changes will occur with cardiac tamponade? A. Increased contractility B. Decreased heart rate C. Decreased stroke volume D. Increased cardiac output - \C. Because the heart cannot adequately fill or eject its contents, stroke volume decreases, which leads to decreased cardiac output. Contractility decreases because the muscle cannot adequately stretch and, therefore, cannot contract effectively.
- Your patient has developed diffuse chest pain and tachycardia. Upon auscultation, you hear muffled heart sounds and note an increased JVD. You suspect the patient has developed a cardiac tamponade. If your patient does have a cardiac tamponade, which of the following findings would you expect on a chest X-ray? A. A dilated superior vena cava B. Pneumothorax C. Narrowed mediastinum D. Delineation of the pericardium and epicardium -
\A. A dilated superior vena cava would appear on a chest X-ray if the patient had a cardiac tamponade. The vena cava is dilated because blood cannot empty into the rights atrium. The mediatinum would be widened. A CXR will not show delineation of the pericardium or epicardium. A pneumothorax may exist, but would not be an expected finding on a X-ray Beck's triad is a combination of symptoms useful in diagnosing tamponade. These symptoms include A. Increased pulse pressure, increased JVD, and tachycardia B. Pericardial friction rub, hypertension, and RV failure C. LV failure, tachycardia, and hypertension D. Distended neck veins, muffled heart sounds, and hypotension - \D. Beck's triad consists of distended neck veins, muffled heart sounds, and hypotension. In tamponade, tachycardia is an early sign. A narrowed pulse pressure occurs; fluid cannot be ejected from the heart. The muffled heart sounds occur because the fluid in the pericaridal sac minimizes the transmission of sound waves.
- During evaluation of CVP pressure monitoring, the c wave represents A. Mechanical atrial diastole B. The decrease in RA volume during relaxation C. Emptying of the right atrium into the RV D. The increase in RA pressure from closure of the tricuspid valve - \D. During CVP pressure monitoring, the c wave represents the increase in RA pressure from closure of the tricuspid valve.
- When evaluating the CPR pressure waves, the v wave represents A. The mechanical atrial diastole B. The increase in RA pressure from closure of the tricuspid valve C. Emptying of the right atrium into the RV D. The decrease in RA volume during relaxation - \A. When evaluating the CVP pressure waves, the v wave represents mechanical atrial diastole.
- A low CVP reading may represent A. Pulmonary hypertension B. Increased contractility C. Biventricular failure D. Cardiac tamponade - \B. A low CVP reading may indicate increased contractility of hypovolemia. A high reading may indicate LV, RV. biventricular failure, tricuspid regurgitatioin or stenosis, hypertension, hypervolemia, or cardiac tamponade.
- An example of a pansystolic murmur is A. Pulmonic insufficiency B. Tricuspid insufficiency C. Atrial stenosis D. Mitral stenosis - \B. By definition, "pansystolic" means the murmur is heard throughout systole. The systolic murmur listed as an option here is tricuspid insufficiency; all of the other answers are diastolic murmurs
- Increased afterload would be present in a patient with which of the following conditions? A. Polycythemia B. Aortic insufficiency C. Hypovolemia D. Sepsis - \A. Polycythemia would increase afterload due to the excess circulation red blood cells. Both hypovolemia and sepsis decrease afterload, as does aortic insufficiency. Aortic stenosis increases afterload, as do peripheral vasoconstriction and hypertension.
- Roxanne had a pulmonary artery catheter placed. When a wedge pressure was initially obtained, large V waves were noted and the PAOP was 27. The probable cause of this reading is A. Equipment malfunction B. Left heart failure C. Papillary muscle rupture D. Right heart failure - \C. When the wedge pressure was initially obtained, large V waves were noted and the PAOP was 27. The probable cause of this reading was papillary muscle rupture. The most important thing to do in this case is to determine the source of the waveform. The large V wave sometimes be mistaken for the right ventricular tracing or even a pulmonary artery tracing. Large V waves usually occur with a papillary muscle rupture (sometimes ischemia) secondary to mitral regurgitaiton or an acute lateral wall MI
- A definitive diagnosis of myocarditis can be made via A. Transmural catheterization B. Transesophageal ultrasound C. Transcutaneous ultrasound D. Endomyocardial biopsy - \D. The only definitive way to diagnose myocarditis is via an endomyocardial biopsy
- Ebstein anomaly has been associated with maternal use of
A. Caffeine B. Lithium C. Cigarettes D. Thalidomide - \B. Environmental factors implicated in the etiology of Ebstein anomaly include maternal ingestion of lithium in the first trimester of pregnancy. Some researchers have reported a teratogenic potential with high doses of lithium, and 400-fold increase in the occurrence of Ebstein anomaly has been noted in association with lithium exposure in utero. In patients with bipolar disorder, the benefits of lithium may outweigh the small risk of Ebstein anomaly. Other possible causes of Ebstein anomaly include maternal rubella, maternal benzodiazepine use, maternal exposure to varnishing substances, and maternal history of previous fetal loss
- Twelve-lead ECG findings for a patient with Ebstein anomaly could include A. Junctional tachycardia B. Wencheback phenomenon C. Sinus rhythm with paraxysmal SVT D. Prolonged PR intervals - \C. Twelve-lead ECG findings for a patient Ebstein anomaly could include sinus rhythm with paroxysmal SVT. Usually, normal sinus rhythm with intermittent SVT, paroxysmal SVT, atrial flutter, atrial fibrillation, and ventricular tachycardia are present. The PR is usually prolonged, accompanied by abnormal P waves consistent with right atrial enlargement. However, PR interval may be normal or short in patients with Wolff- Parkinson-White syndrome.
- Cardiac glycosides are often used in the treatment of Ebstein anomaly. A major effect of this class of medication is A. Increased conductivity B. Positive chronotropism C. Its usefulness as a ventricular antiarrhythmic D. Inotropism - \D. Cardiac glycosides possess positive inotropic activity, which is mediated by inhibition of sodium-potassium adenosine triphosphatase. Also, cardiac glycosides reduce conductivity in the heart, particulary through the atrioventricular node, and therefore have a negative chronotropic effect. The cardiac glycosides have very similar pharmacological effects but differ considerably in terms of their speed of onset and duration of action. They are used to slow the heart rate in supraventricular arrhythmias, especially atrial fibrillation, and also are used in patients with chronic heart failure.
- Which heart valves is most rarely affected by infective endocarditis? A. Tricuspid B. Pulmonic
- Which of the following drugs would be used for a hypercyanotic spell often seen with tetralogy of Fallot? A. Digoxin B. Epinephrine C. Norepinephrine D. Neo-Synephrine - \D. Neo-Synephrine is used as a treatment for hypercyanotic tet spells. It is also used to treat SVT and severe hypotension.
- An infant was born at 39 weeks gestation via cesarean section because of persitent fetal tachycardia. At day 2 of life, severe tachypnea developed. Blood cultures were obtained and all labs were normal. The tachypnea resolved. The infant was discharged home on day 4 of life. That evening, the infant became apneic and bradycardic and was admitted to the PICU. Antibiotics were started. The next morning, the developed a fever, DIC, jaundice, slight hepatomegaly, and hepatitis. Labs show high numbers of bands and an elevated platelet count. A diagnosis of myocarditis was made. A likely causative agent for this condition is A. Group B Streptococcus B. Escherichia coli C. Coxsackie B1 virus D. Halothane toxicity - \C. Myocarditis is clinically defined as inflammation of the myocardium. Coxsckie B virus has emerged as a more prevalent cause of myocarditis in recent years. In addition, numerous infections, systemic diseases, drugs, and toxins are associated with the development of myocarditis. Viruses, bacteria, protozoa, and even worms have been implicated as infectious agents. The normal WBC count in neonates varies, but a value of less than 4000 WBCs/microL or more than 25,000 WBCs/microL is considered abnormal. The absolute band count is not sensitive enough to predict the development of sepsis, but a ratio of immature to total polymorphonuclear leukocytes of less than 0. has a very high negative predictive value. A rapid fall in a known absolute eosinophil count and morphologic changes in neutrophils may indicate sepsis.
- Right ventricular afterload may be reduced by A. A hypoxic state B. Hypoventilation C. Inhaled nitric oxide D. Administration of epinephrine - \C. Right ventricular afterload may be reduced by inhaled nitric oxide. Use of epinephrine will increase systemic afterload due to vasoconstriction and promote increased PVR because of the increased left heart pressures. Hypoventillation and subsequent hypoxia will also increase right heart afterload. Use of inhaled nitric oxide, nitroglycerin, nitroprusside, PGE1, or hyperventilation will reduce right ventricular afterload.
- Mast cell degranulation with resultant histamine release and vasodilation would be an appropriate definition of A. Septic shock B. A pleural effusion C. Anaphylaxis D. MODS - \C. Anaphylaxis-a form of distributive shock-involves mast cell degranulation with resultant histamine release and vasodilation. The histamine release may cause normal peripheral vascular tone to become inappropriately relaxed. Vasodilation results in increased venous capacitance, leading to a relative hypovolemia even if the patient has not actually lost any net fluid. The common physiologic disturbance in all forms of distributive shock is a decrease in preload.
- Systemic inflammatory response syndrome (SIRS) can best be defined as A. Sepsis with cardiovascular failure B. Sepsis with accompanying organ failure C. Tachycardia or tachypnea with a fever D. Systemic organ dysfunction - \C. The international consensus conference in 2002 standardized the definition of systemic inflammatory response syndrome (SIRS) as tachycardia or tachypnea with fever or high leukocyte count. Sepsis is defined as SIRS in the presence of suspected or proven infection. Severe sepsis is defined as sepsis with accompnaying organ dysfunction. When cardiovascular failure occurs in the setting of sever sepsis, then it is classified as septic shock.
- Sandra is a cheerleader at her middle school. Today Sandra was admitted for increased exercise intolerance, syncope, severe edema, dyspnea at rest, and decreased LOC. A pulmonary artery catheter was placed and the following pressures were obtained: RAP = 20 PA = 65/ RV = 64/ PAOP = 13 You would suspect Sandra is suffering from A. Cardiac tamponade B. Pulmonary hypertension C. A pulmonary embolus D. Congestive heart failure - \B. The elevated right ventricular pressure and the elevated right atrial pressure indicate pulmonary hypertension. The wedge pressure is normal. The wedge pressure reflects the status of the left side of the heart. Fluid cannot clear the lungs, so pressure builds and the right-side pressures become elevated due to the increased workload. Edema
may result in tachycardia and severe hypotension. Monitor the patient's venous O concentration and acid-base balance. If ntiroprusside extravasates from an IV, it will cause tissue sloughing and necrosis. The RBC cyanide level should be less than 50 mcg/mL.
- Julie is 15 years old and just gave birth to Charlie. Julie has lupus, so Charlie is at risk for cardiomyopathy and A. Myocarditis B. Blister of the skin C. Congenital heart block D. Weight gain - \C. Charlie is at risk for cardiomyopathy and congenital heart block. Neonatal congenital heart block is thought to occur when maternal antibodies pass through the placenta into the fetal circulation. Some infants with congenital heart block are treated with corticosteroids and have limited mediation of symptoms; these symptoms may include thrombocytopenia, skin rash, and hepatitis. Even if the symptoms resolve, some research has shown that affected infants often develop a variety of autoimmune disorders later in life. If the congenital complete heart block does not resolve, it will become permanent. In approximately two-thirds of all infants with complete heart block, a pacemaker is required.
- Adverse effects of procainamide include A. Derpession of the excitability of cardiac muscle B. Junctional tachycardia C. Slowing conduction in the atria D. Severe hypotension - \D. Procainamide's adverse effects include sever hypotension (usually because of a rapid infusion) and A-V block. Procainamide may also widen the QRS complex due to slow impulse conduction through the Purkinje fibers and ventricular myocardium. If the QRS complex widens more than 35% to 50%, use of procainamide should be discontinued. Adverse effects usually disappear when the drug is discontinued. Two of procainamide's actions are depression of the excitability of cardiac muscle and slowing of the conduction in the atria.
- Which of the following statements is true about pericardial effusion? A. Diastolic filling is increased B. On CXR, a "water bottle" silhouette is noted C. The voltage of the QRS complex is increased D. This is a painless, hard to diagnose condition - \B. The classic description of an X-ray showing a pericardial effusion is the "water bottle" silhouette. In patients with a pericardial effusion, QRS amplitude is decreased. Diastolic filling is decreased as well.
- Which of the following pulmonary artery pressures would be considered in the normal ranger for a 14 year old? A. PAP = 40/24, PAOP = 15 B. PAP = 14/8, PAOP = 4 C. PAP = 24/12, PAOP = 9 D. PAP = 36/30, PAOP = 22 - \C. Normal pulmonary artery pressures are as follows: PAS = 20-30 / 6-10 mmHg PAD = 5-12 mmHg PAM = 10-20 mmHg PAOP (PCWP) = 4-12 mmHg
- You are mentoring a new nurse in the PICU. The patient you wil be caring for is receiving lidocaine via a continuous infusion. The new PICU nurse must know that lidocaine may cause adverse effects such as A. Hyperexcitability B. CNS toxicity C. Ventricular tachycardia D. Premature atrial complexes - \B. Signs of CNS toxicity from lidocaine may include agitation, vomiting, drowsiness, and muscle twitching. Later signs may include loss of consciousness, seizures, respiratory depression, and apnea. Cardiac toxicity may develop and cause hypotension, bradycardia, and heart block, ultimately leading to cardiovascular collapse
- Jane is 9 years old and has a PAOP (PCWP) of 4. She is restless and mildly tachycardic. Absent any specific cardiac issue, you anticipate which of the following interventions? A. Administration of an inotrope B. Volume replacement C. Administration of a vasoconstrictor to increase afterload D. Administration of nitroprusside to decrease preload - \B. The low wedge pressure of 4 indicates hypovolemia. this patient will require volume replacement.
- Micah is a 15 year old Jehovah's Witness who has just undergone a cardiac surgical procedure. His Hgb and Hct are falling and are now Hgb 6.5 and the Hct 24. Micah's chest tubes have drained 960 mL in the last four hours. The anticipated treatment would be to A. Administer 500 mL of albumin B. Administer one unit of type specific whole blood C. Administer 250 mL of fresh frozen plasma
